Digital platforms can increase COVAX uptake. We explain.

Posted Fevereiro 10, 2022
Impact Area COVID-19

By Steve Maina, Social Media Optimization Manager, Digital Health and Monitoring and Judy Mwangi, East Africa Regional Monitoring Advisor, Digital Health and Monitoring, PSI

Driving global behavior change for COVID-19 prevention and vaccine uptake using Meta tools

Omicron is here. COVID prevention and vaccines are integral to stemming the rising tide of global infections.

At PSI, mobile-based digital solutions are an integral part of driving critical and life-saving behavior change.

The evidence shows that advancements in mobile phone technology enable us all to reach global audiences with information within a very short time. However, these channels come with inadvertent effects of spreading misinformation on public health matters like COVID-19 knowledge, prevention and more so, vaccination efforts.

How can we leverage the power of digital and the reach of mobile to deliver life-saving and trusted health information to consumers – everywhere?

Alongside 26 PSI country offices across Africa, Asia and Latin America, we partnered with Meta (formerly Facebook) to design and deliver social behavior change (SBC) campaigns on Facebook and Instagram to do our part in curbing the ever-evolving pandemic.

Emerging Insights

But first, we needed data.

Using Meta’s Audience Insights’ tool and the University of Maryland COVID Trends and Impact Survey, we identified communities who were especially hesitant to follow COVID prevention and vaccine guidance, the key elements fuelling COVID-19 misinformation, and barriers to vaccine uptake. We gained insights into consumers’ preferences for vaccine uptake and how we could pave access to support consumers to choose to get a COVID vaccine.

Among key insights:

Most countries witnessed a lower perception of vaccine safety compared to vaccine importance. Even though over 57 percent of Meta users in Cambodia understood the importance of COVID-19 vaccines; only 64 percent thought COVID-19 vaccines were safe.
Overall, vaccine hesitancy was higher among African countries as compared to most other continents. For instance, among countries with the highest hesitancy in Asia (Pakistan, Afghanistan, Siri Lanka and India), average hesitancy was around 40 percent; while Cameroon, Tanzania, DRC, and Benin recorded the highest hesitancy in Africa (approx. 56 percent).
COVID vaccine hesitancy among women was mainly attributed to vaccine safety and side effects.

Developing Insight-Driven Digital Health Campaigns

Countries began by reviewing vaccine hesitancy data among key target populations by age, gender, geographies, and where people turned to for COVID-19 prevention information. From there, they designed appropriate campaigns to reach consumers with relevant, quality and tailored information:

The Cambodia Bokator that was watched 18 million times

To address concerns on safety and side effects, we developed audience-tailored campaigns on Meta tools that highlighted the rigorous scientific testing and safety records of the COVID-19 vaccines. Campaigns included a Meta Messenger-based chatbot where users could access frequently asked questions and WHO-developed content on COVID-19 vaccines.
PSI used localized content to drive higher engagement rates, such as PSI Cambodia’s use of a ‘Bokator’ (Ninja) character in the Khmer language.
Using the latest national COVID-19 infection rates and vaccine availability data, PSI India prioritized COVID-19 prevention campaigns rather than a vaccine uptake campaign during the delta variant surge in mid-2021.

Our Impact

26 countries underwent Meta-led trainings to design and run campaigns related to vaccine confidence, preventative behaviours and combating misinformation.

The outcome:

In Focus: Changing COVAX Behavior—For Good
In Mozambique, campaign activities resulted in a significant lift on perceptions of safety and importance. This implies that people who had the opportunity to see the ads had additional positive responses to the campaign compared to those who did not see the ads. The lift was higher among males aged 18-24.

At the height of the pandemic, over 95% of women in India already understood the importance of wearing a mask—and yet only 84% reported wearing one to prevent the spread of COVID-19. PSI India, through its COVID-19 campaigns, created a significant lift among in motivating audience to wear masks, especially younger women aged 25-34.

In Angola, our campaigns led to a significant increase in people washing their hands and practicing social distancing.

Reach: As of December 30,2021, PSI reached over 160 million people, with over 1 billion impressions secured through our campaigns.
Social behaviour change: PSI ran campaigns measured by Brand Lift Studies (BLS) in 15 countries, with many recording positive impact on COVID-19 knowledge, attitudes, intentions and practices as a result of the SBC campaigns.

Factors driving success in the campaigns

Data-informed decisions: PSI country teams leveraged Facebook’s Data for Good resources, including data on COVID-19 cases, prevention practices, vaccination rates, vaccine hesitancy rates and reasons categorised by age, gender, location to identify potential high impact target audiences in each country and design relevant campaigns.

Kenya ad that featured a priest to encourage people to get vaccinated

Localizing ideas: PSI country teams created their own content, aligning ads with local government campaigns and other contextual factors like culture, trusted influencers and channels (i.e WHO website).
Adaptations: Once campaigns were activated, teams continually monitored engagement statistics and BLS results to further adapt messaging approaches for subsequent campaigns. In many cases, factual information on COVID-19 received higher engagement rates, as well as testimonial content from country leaders and celebrities taking the vaccine.

Looking Ahead

There is a significant opportunity for public health organizations and Ministries of Health to collaborate and develop best practice for using consumer digital health tools, like the Meta suite.

PSI seeks partners to develop engaged consumer digital health communities of practice to share experiences, learn from each other and provide platforms for partners to collaborate and develop open-source global goods and guidance on the use of social media platforms for health. Working together, public health implementers and partners can leverage digital platforms to reach consumers cost-effectively and at scale for health impact during COVID-19 pandemic and beyond.

Interested in working together? Contact Martin Dale ([email protected]).

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

By: Fana Abay, Marketing and Communications Director, PSI Ethiopia

In rural Ethiopia, women and girls often face significant barriers in accessing healthcare facilities, which can be located hours away. Moreover, there is a prevailing stigma surrounding the use of contraception, with concerns about potential infertility or the perception of promiscuity. To address these challenges, the Smart Start initiative has emerged, linking financial well-being with family planning through clear and relatable messaging that addresses the immediate needs of young couples—planning for the lives and families they envision. Smart Start takes a community-based approach, utilizing a network of dedicated Navigators who engage with women in their localities. These Navigators provide counseling and refer interested clients to Health Extension Workers or healthcare providers within Marie Stopes International-operated clinics for comprehensive contraceptive counseling and services.

In a significant development, PSI Ethiopia has digitized the proven counseling messaging of Smart Start, expanding its reach to more adolescent girls, young women, and couples. This approach aligns with the priorities set by the Ethiopian Ministry of Health (MOH) and is made possible through funding from Global Affairs Canada. The interactive and engaging digital messaging has revolutionized counseling services, enabling clients to make informed and confident decisions regarding both their finances and contraceptive choices.

Clients who received counseling with the digital Smart Start tool reported a higher understanding of their options and were more likely to choose contraception (74 percent) compared to those counseled with the manual version of Smart Start (64 percent). Navigators also found the digital tool more effective in connecting with clients, leading to higher ratings for the quality of their counseling.

By December 2023, PSI Ethiopia, working in close collaboration with the MOH, aims to reach over 50 thousand new clients by leveraging the digital counseling tool offered by Smart Start. This innovative approach allows for greater accessibility and effectiveness in providing sexual and reproductive health services, contributing to improved reproductive health outcomes for women and couples across the country.

Building community health worker capacity to deliver malaria care

By: Christopher Lourenço, Deputy Director, Malaria, PSI Global

Community health workers (CHWs) are critical lifelines in their communities. Ensuring they have the training, support, and equipment they need is essential to keep their communities safe from malaria, especially in the hardest to reach contexts.

For example, in Mali, access to formal health services remains challenging, with four in ten people living several miles from the nearest health center, all without reliable transportation or access. In 2009, the Ministry of Health adopted a community health strategy to reach this population. The U.S. President’s Malaria Initiative (PMI) Impact Malaria project, funded by USAID and led by PSI, supports the Ministry with CHW training and supervision to localize health services.

In 2022, 328 thousand malaria cases were recorded by CHWs); 6.5 thousand severe malaria cases were referred to health centers, according to the national health information system.

During that time, the PMI Impact Malaria project (IM) designed and supported two rounds of supportive supervision of 123 CHWs in their workplaces in the IM-supported regions of Kayes and Koulikoro. This included developing and digitizing a standardized supervision checklist; and developing a methodology for selecting which CHWs to visit. Once a long list of CHW sites had been determined as accessible to supervisors for a day trip (including security reasons), the supervisors telephoned the CHWs to check when they would be available to receive a visit [as being a CHW is not a full-time job, and certain times of the year they are busy with agricultural work (planting, harvesting) or supporting health campaigns like mosquito net distribution].

Supervisors directly observed how CHWs performed malaria rapid diagnostic tests (RDTs) and administered artemisinin-based combination therapy (ACT). They recorded CHW performance using the digitized checklist, interviewed community members, reviewed records, and provided on-the-spot coaching. They also interviewed the CHWs and tried to resolve challenges they expressed, including with resupply of commodities or equipment immediately or soon afterwards.

Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact.

In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent.

Supportive supervision with interviews and observations at sites improved the basic competencies of CHWs between the first and second rounds, and additional rounds will help to understand the longer-term programmatic benefits.

Taking a market-based approach to scale sanitation in Ethiopia

By: Dr. Dorothy Balaba, Country Representative, PSI Ethiopia

In Ethiopia, PSI leads the implementation of USAID Transform WASH (T/WASH) activity with consortium partners, SNV and IRC WASH. Contrary to traditional models that rely on distribution of free or heavily subsidized sanitation products, T/WASH utilizes a market-based sanitation approach. This approach creates sustainable and affordable solutions, by integrating market forces and supporting businesses to grow, while creating demand at the household level.

During the last six years, T/WASH has worked alongside the private sector and government (Ethiopia’s Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills), among other stakeholders, to increase household access to affordable, quality sanitation products and services. For example, more than 158 thousand households have invested in upgraded sanitation solutions with rapid expansion to come as the initiative scales and market growth accelerates.

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To share the journey to market-based sanitation, representatives of the Ethiopian Ministry of Health and the USAID Transform WASH team took to the stage at the UN Water Conference in 2023.

“Rather than relying on traditional aid models that often distribute free or heavily subsidized sanitation products, market-based sanitation creates sustainable and affordable solutions, integrating market forces and supporting businesses to grow.”

— Michael Negash, Deputy Chief Party of T/WASH

Promoting self-managed care like Self-testing and Self-Sampling

By: Dr Karin Hatzold, Associate Director HIV/TB/Hepatitis

Building upon the success and insights gained from our work with HIV self-testing (HIVST), PSI is actively applying this approach to better integrate self-care, more broadly, in the health system beginning with Hepatitis C and COVID-19. Self-testing has emerged as a powerful tool to increase access to integrated, differentiated, and decentralized health services, accelerating prevention, care, and treatment for various diseases, while also increasing health system resilience against COVID-19.

Here’s how we got there.

Seven years ago, the landscape of HIV self-testing lacked global guidelines, and only the U.S., the UK and France had policies in place that allowed for HIV self-testing. High disease burdened countries in low-and-middle-income-countries (LMICs) lacked evidence and guidance for HIVST despite major gaps in HIV diagnosis.

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Given the success of the program, South Africa’s Department of Health and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) have each embraced the Coach Mpilo model in their health strategy and are embedding it in their strategies and programs.

“The men we spoke to [while I was traveling to South Africa for a PrEP project with Maverick Collective by PSI] were not only decidedly open to the idea of taking a daily pill…many were willing to spread the word and encourage friends to get on PrEP too. We were able to uncover and support this new way forward because we had flexible funding to focus on truly understanding the community and the root barriers to PrEP adoption. This is the philanthropic funding model we need to effectively fight the HIV epidemic, and it’s beneficial for all sorts of social challenges.”

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simplifying consumers’ journey to care in Vietnam

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Babylon’s AI symptom checker and PSI’s health provider locator tool captures real-time, quality data that supports health systems to plan, monitor and respond to consumer and provider needs. But for this data to be effective and useable, it needs to be available across the health system. Fast Healthcare Interoperability Resources (FHIR) standard provides a common, open standard that enables this data exchange.
PSI’s first consumer-facing implementation of FHIR was launched in September 2022 as part of the Babylon Symptom Checker project in Vietnam, enabling rapid alignment between PSI and Babylon’s FHIR-enabled client records systems. PSI already has several other consumer health FHIR implementations under active development in 2023, including PSI’s collaboration with the Kenya MOH to launch a FHIR-enabled WhatsApp national health line for COVID-19 health information. PSI will also look to adopt and scale health workforce-facing FHIR-enabled tools, such as OpenSRP2, which will be piloted in an SRH-HIV prevention project in eSwatini in partnership with Ona by the end of 2023.

— Martin Dale, Director, Digital Health and Monitoring, PSI

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Under a three-year investment from the Indo-Pacific Center for Health Security under Australia’s Department for Foreign Affairs and Trade (DFAT), PSI is enhancing disease outbreak surveillance and public health emergency preparedness and response capacities in Myanmar, Cambodia, Laos, and Vietnam. When PSI conducted a review of existing disease surveillance systems in Myanmar, it identified several gaps: although the Ministry of Health had systems in place for HIV, tuberculosis, malaria and other communicable diseases, they were fragmented, with different reporting formats and reliance on paper-based reporting. In addition, private sector case surveillance data were not routinely captured, yet private clinics and pharmacies are the dominant health service delivery channel in the country. This hindered effective disease prevention and control efforts.

Building on our extensive private sector malaria surveillance work under the BMGF-funded GEMS project in the Greater Mekong Subregion, PSI implemented a case-based disease notification system using social media channels to overcome the limitations of paper-based and custom-built mobile reporting tools. These chatbots, accessible through popular social media platforms like Facebook Messenger and Viber, proved to be user-friendly and required minimal training, maintenance, and troubleshooting. The system was implemented in more than 550 clinics of the Sun Quality Health social franchise network as well as nearly 470 pharmacies. The captured information flows to a DHIS2 database used for real-time monitoring and analysis, enabling rapid detection of potential outbreaks. Local health authorities receive instant automated SMS notifications, enabling them to promptly perform case investigation and outbreak response.

In 2022, private clinics reported 1,440 malaria cases through the social media chatbots, while community mobilizers working with 475 private providers and community-based malaria volunteers reported more than 5,500 cases, leading to the detection of two local malaria outbreaks. Local health authorities were instantly notified, allowing them to take action to contain these surges in malaria transmission. During the same time, pharmacies referred 1,630 presumptive tuberculosis cases for confirmatory testing – a third of which were diagnosed as tuberculosis and enrolled into treatment programs.

Training health workers in Angola

By: Anya Fedorova, Country Representative, PSI Angola

The shortage of skilled health workers is widely acknowledged as a significant barrier to achieving Universal Health Coverage. To address this challenge, PSI supported ministries of health to develop a digital ecosystem that brings together stewardship, learning, and performance management (SLPM). The ecosystem enhances training, data-driven decision-making, and the efficiency of healthcare delivery.

Here’s what it looks like in practice.

In July 2020, PSI Angola, alongside the Angolan digital innovation company Appy People, launched Kassai, an eLearning platform that targets public sector health workers in Angola. Through funding from USAID and the President’s Malaria Initiatve (PMI), Kassai features 16 courses in malaria, family planning, and maternal and child health – with plans to expand learning topic areas through funding from ExxonMobil Foundation and private sector companies. A partnership with UNITEL, the largest telecommunication provider in Angola, provides all public health providers in Angola free internet access to use Kassai.

Kassai’s analytics system to follow learners’ success rate and to adjust the course content to learners’ performance and needs. Kassai analytics are integrated with DHIS2 – the Health Management Information System (HMIS) of Angolan MOH, to be able to link learners’ knowledge and performance with the health outcomes in the health facilities. The analytics track learners’ performance by course and gives visibility by health provider, health facility, municipality, and province. Each course has pre-and post-evaluation tests to track progress of learning, too.

By the end of 2022, there were 6,600 unique users on the Kassai platform and 31,000 course enrollments. PSI Angola’s partnership with UNITEL, the largest telecommunication provider in Angola, allows for free internet access to learn on the Kassai for all public health providers in Angola. Building on its success for malaria training, Kassai now also provides courses in family planning, COVID-19, and maternal and child health. This reduces training silos and provides cross-cutting benefits beyond a single disease.

Implementing the SLPM digital ecosystem brings numerous benefits to health systems. It allows for more strategic and efficient workforce training and performance management, enabling ministries of health to track changes in health workers’ knowledge, quality of care, service utilization, and health outcomes in real time. The ecosystem also supports better stewardship of mixed health systems by facilitating engagement with the private sector, aligning training programs and standards of care, and integrating private sector data into national HMIS. Furthermore, it enables the integration of community health workers into the broader health system, maximizing their impact and contribution to improving health outcomes and strengthening primary healthcare.

Digital platforms can increase COVAX uptake. We explain.

Driving global behavior change for COVID-19 prevention and vaccine uptake using Meta tools

Emerging Insights

Developing Insight-Driven Digital Health Campaigns

Our Impact

Factors driving success in the campaigns

Looking Ahead

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The Consumer as CEO

Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

Building community health worker capacity to deliver malaria care

Taking a market-based approach to scale sanitation in Ethiopia

Promoting self-managed care like Self-testing and Self-Sampling

Using peer coaches to counter HIV stigma in South Africa

simplifying consumers’ journey to care in Vietnam

Engaging the private sector for disease surveillance in Myanmar

Training health workers in Angola

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