Data-Driven Design – And a Game – Pave the Path to Health Services for Young People Living near Lake Malawi
Published on August 30, 2023
By Angela Pereira, Communications Team Lead, MOMENTUM Country and Global Leadership and Corrine Reilly, Writer, Pact Communications Team
The shores of Lake Malawi, the most biologically diverse lake in the world, are home to vibrant fishing communities that rely on the lake as a vital source of nutrition and livelihoods. Yet in these communities, gender norms and power imbalances within households can often limit the autonomy of adolescent girls and young women—including their ability to make decisions about their own health and income. The economic power imbalances can also leave adolescent girls and young women vulnerable to unsafe sexual practices.
In response, MOMENTUM Country and Global Leadership is partnering with USAID’s Restoring Fisheries for Sustainable Livelihoods in Lake Malawi (REFRESH) project to provide family planning and reproductive health services to adolescents and youth in communities along Lake Malawi. The partnership is an opportunity to integrate MOMENTUM’s sexual and reproductive health programming into REFRESH’s biodiversity and conservation focus. The plan is to use lessons learned from the collaboration to inform future population, environment, and development projects.
While literature exists about obstacles to sexual and reproductive health services in fishing communities, little is published on these obstacles among such populations in Malawi. To fill this evidence gap, MOMENTUM conducted an assessment on the needs of adolescents and youth in two districts along Lake Malawi — Mangochi and Nkhata Bay. Understanding the factors that can both enable and hinder their access to family planning and reproductive health services was the first step in designing an intervention to improve health outcomes among this population. Programming was then designed with the communities. Adolescents, youth club members, beach village committee[TP1] s–which are the governing structure in the communities– and government stakeholders were involved.
“Evidence-based and data-driven implementation design paired with co-creation and stakeholder buy-in are critical to ensuring that global development programming is effective,” says Tripti Pande, Senior Officer – Learning, Evidence and Impact, on the MOMENTUM team. “They enable us to answer key questions about the needs and wishes of communities, our methods and results, and whether we are truly listening to and serving communities.”
The assessment used a qualitative approach, with focus group discussions and individual interviews conducted in Chichewa, the local language. Focus groups gathered information from adolescents and youth while interviews targeted key stakeholders such as local leaders, health surveillance assistants, and health facility managers. The results were clear: Adolescents and youth in fishing communities continued to have an unmet need for family planning and reproductive health services.
Overcoming barriers with a game
Topics such as sexual and reproductive health services can be sensitive because of stigma and privacy. With this in mind, the team used a special approach to data collection through an educational tool, Pathways to Change, developed by Pathfinder International. The tool is a game similar to Chutes and Ladders that assists in data collection in a focus group format and illuminates ways to influence changes in behavior. By using fictional stories and characters, the game creates a safe space for youth to share their thoughts without speaking about their personal experiences.
Using the game, participants reported barriers to accessing youth-friendly sexual and reproductive health services. These included: limited skills of health care workers; a lack of privacy in health centers; few local youth groups and clubs; community and household-level stigma; power imbalances between men and women; fear of parents; and misinformation.
Generally, girls and young women were more interested in the game than their male counterparts. It wasn’t until the second day that the boys engaged in the game. Boys and girls played the game separately, divided into groups by age.
Design driven by communities
The MOMENTUM team designed programming in response to the assessment findings and shared the results with the Reproductive Health Directorates in Mangochi and Nkhata Bay. Together, they then set objectives and developed activities to achieve them in collaboration with key local stakeholders, including youth clubs and fishery associations.
“We plan to partner with a local youth-serving organization to implement activities,” says Pande, “This includes engaging male and female champions and mentors selected by the community; community-led dialogue sessions; joint meetings between the health and fishing sectors; and reflection sessions with key stakeholders.”
As activities continue, MOMENTUM will gather ongoing learning to better understand the successes and challenges of integrating population, environment, and development into a single activity. Governing bodies within fishing communities – Beach Village Committees – will serve as one of the pivotal entry points for intervention activities, along with youth clubs. Members from each of the two structures will be trained to lead community dialogue sessions with parents and other fisherfolk as well as in adolescent safe spaces.