Youth Boost: a stepping stone for expansion

Published on 01 October 2024 | Simon Moore and Lucy Gale

OPHID and Avert have been partners in developing the Boost job aid for community health workers and evaluating its impact since 2019. Boost was developed to give community health workers the accessible, up-to-date knowledge they need to share accurate and actionable HIV, SRH, and other primary health information with their communities.

From late 2021, the Youth Boost project, supported by the Vitol Foundation, enabled the app to be enhanced with new local Zimbabwean language versions and simple screening tools. It was then integrated across OPHID’s large scale USAID programme, supporting the knowledge and confidence of its Community Outreach Agents (COAs), and helping them increase screenings and referrals among young people across the nine programme districts predominantly in the south of Zimbabwe.

What was achieved

By the end of the project in April 2024 (OPHID’s use of Boost continues on), over 224,435 quality health consultations had been carried out by COAs using Boost’s up-to-date information content and its intuitive screening tools available in Shona, Ndebele and English. This led to over 93,200 referrals of young people aged 10-24 to HIV, STI and mental health services in their area. Health facility data showed an increase in HIV self-tests, facility HIV tests, and STI service uptake in those districts as a result.

Findings from the project’s endline survey also showed improved knowledge and awareness, and increased confidence among Boost users.

97% said they were equipped with the HIV testing and STI information they needed.
97% agreed that Boost is helpful in providing health knowledge.
90% said Boost gives them confidence to do their daily routine duties.
87% said Boost helps them interact with young people in their communities.

This built on previous evaluation results which found that 100% of COA supervisors said using Boost increased their COAs’ quality of service.

These results highlight Boost’s effectiveness in supporting community health cadres’ confidence and effectiveness, improving service uptake, and supporting the healthcare needs of young people and others in the community.

“I am not trained technically like the nurses to give out health information, but thanks to Youth Boost trainings, as a COA, I am going to speak eloquently and respond with confidence on all health topics I will be asked about by my fellow peers using my pocket friend the Youth Boost application.“

What we learnt

Youth Boost also provided important insights and learning into why Boost is effective as a programme tool, and how to most effectively roll out this kind of digital health tool with community health cadres in the Zimbabwean context.

Accessibility of content: COAs consistently fed back that Boost’s key strength is its accessible content – both in terms of language and interface - and the way in which health information can be understood with no need for any prior subject knowledge from either clients or community health workers themselves.

Simplicity of tools: the screening tools fit with the way community cadres work, providing them a structure for their engagement with clients, and easy prompts to ensure key information is passed on. COAs were keen to have more data on their own screenings and screening targets (something being incorporated into the next update of Boost).

Ongoing refresher trainings: there is a critical need to keep conducting project refresher trainings with community cadres to revisit the project’s objectives, goal and targets and ensure their skills on using Boost remain up to date. Role plays with the Boost app and mock scripts also supported learning and confidence.

Cascaded roll out: a model of training of trainers and cascading sensitisation training across the entire organisation ensured that the app had the support and understanding of all levels and areas of the organisation, avoiding it becoming siloed.

Community mapping: community mapping exercises using ‘transect’ walks (intentionally crossing a community) mapped the communities for youth hang-out places and risk ‘hot spots’ to enable more targeted screening of young people. It also identified phone network infrastructure in the communities for uploading data and CBOs working with young people who could enhance community outreach activities and screening. The results of the exercise helped improve the effectiveness of the programme and increase the number of youth screenings.

Meeting young people where they are: building on the community mapping results, blitz activities were successfully used to maximise community screenings for 10-24 year olds, for example at local sports galas and church gatherings. These activities achieved a significant increase in adolescent screenings.

Learning exchange visits: learning exchange visits between different implementation districts were effective for knowledge sharing and motivating and inspiring COAs to do their daily routine duties. Important recommendations for programme improvement also came out of the visits such as recruitment of age appropriate COAs to increase engagement, gender balance for inclusivity, and provision of identifiable uniforms to increase trust within the community.

Data driven improvement: access to analytics dashboards segregating information usage and screening data by district, health facility, and role played a key part in enabling enhanced performance-based monitoring and rapid remedial action and support in areas where needed.

"Youth Boost has been a stepping stone for Avert to transition Boost to OPHID in Zimbabwe and LVCT Health in Kenya to increase the long-term sustainability and impact of Boost and provide a model for the sector of locally led digital interventions."

A stepping stone to expansion

Over the two and half years of the Youth Boost project, Avert and OPHID have worked closely together building a joint understanding of how to successfully develop and implement a digital job aide in the Zimbabwean context. Lessons from the roll out, training and monitoring of Boost are now being adapted into models that can inform wider Boost roll out with other community cadres. Through the learning generated by the project we have also gained evidence on the wider relevance and applicability of Boost to other community cadres in Zimbabwe and across the region.

This potential is now being realised in two ways. Firstly, through support from ViiV Positive Action Avert and OPHID are now supporting four new organisations to adopt Boost in Zimbabwe substantially increasing the number of CHWs using Boost and broadening the types of organisations using the app. This will also improve the generalisability of the evidence around Boost outcomes. Also through support from ViiV Positive Action, the lessons from Zimbabwe are now being used to roll out a re-branded Swahili version of the app in Kenya with national NGO LVCT Health.

More broadly, with support from the Vitol Foundation, Youth Boost has been a stepping stone for Avert to transition the overall ownership and management of Boost to OPHID in Zimbabwe and LVCT Health in Kenya as part of Avert’s wider transition strategy. We hope this will increase the long-term sustainability and impact of Boost and provide a model for the sector of locally led digital interventions.

Photo credit: Hilton Matyatya. Photos are used for illustrative purposes. They do not imply health status or behaviour.