Chakruok Interactive Radio Program

This case study was originally published in the mHealth Compendium Volume 1, developed by the African Strategies for Health project, implemented by Management Sciences for Health with support from the U.S. Agency for International Development (USAID). Updates to the original case study, submitted by the implementing organization in March 2021, appear in the final section of this case study.

Introduction

Married adolescent girls have relatively poorer health and use fewer health services than their unmarried peers in developing countries. Improving their access to critical services, including those related to reproductive health and HIV, is still a challenge. Studies from around the world indicate that married girls are often isolated and have limited access to information in general. There is often a generational gap between married girls and their partners, making contraceptive use negotiation and the uptake of other reproductive health services difficult. Yet, married girls often have sex more frequently than their unmarried peers, given the constant availability of their marriage partners.

In order to address these issues, Population Council, through the USAID-funded APHIA II Operations Research (OR) Project, in collaboration with Well Told Story and the Kenyan Ministry of Public Health and Sanitation, designed and implemented a community health project that included a radio program with an interactive mHealth component. The goal was to expand access to reproductive health and family planning (RH/FP), as well as HIV information and services for married adolescent girls in order to improve their reproductive health outcomes.

The project was implemented in Homa Bay and Rachuonyo Districts of Nyanza Province, Kenya, between 2009 and 2011.

About Chakruok

Well Told Story, in collaboration with the APHIA II OR project, developed a radio soap opera series revolving around the life of a married adolescent girl, consisting of 20-minute episodes. The soap opera aired twice a week in the evenings, along with a weekly discussion segment exploring key educative topics. Entitled Chakruok (meaning ‘Beginnings’ in Dholuo), the soap opera was aired on three FM stations in Nyanza province over an eight-month period.

Text messaging and call-ins were incorporated into the radio drama to encourage listener participation and communication about the RH/FP and HIV issues raised in the episode concerned. During the weekly discussion segment of the radio show, some listeners who sent in text messages or letters were telephoned for interviews, and a pre-recorded interview with an expert in that week’s topic was played. A Facebook page was also set up for listeners to explore the issues raised in the show in more detail. Several times a week, different questions were posted on the Facebook page to encourage discussion and debate.

Leaflets referencing the radio soap opera were developed (in Dholuo language) to accompany the key topics explored within Chakruok and to link readers to the radio program. Each leaflet tackled a separate topic. Leaflets were distributed to married adolescent girls by community health workers (CHW) during periodic home-visits, and were also mailed free, twice monthly, to Chakurok listeners who requested copies, sending in their names and addresses via text message.

Evaluation and Results

In the course of the radio programming, 3,407 questions and comments were texted to the Charuok radio program, and the Chakruok Facebook page had garnered 406 Facebook fans. By the end of project survey, study results revealed that 66 percent of married adolescent girls interviewed had either listened to Chakruok, or been visited by a CHW in the past one year. There was an increase in demand and utilization of family planning methods among married adolescents. Additionally, support from partners of the married adolescent girls increased.

Based on evaluation surveys, researchers noted that there was a significant change in the following indicators by the end of the project:

• Increased uptake of family planning methods (including long-acting methods) among married adolescent girls;
• Increased support among partners for married adolescent girls’ access to reproductive health services;
• Increased attendance at the four recommended antenatal care visits among married adolescent girls exposed to the intervention;
• Decreased use of unskilled birth attendants during the last pregnancy among married adolescent girls;
• Increased use of postnatal care services within 48 hours of delivery among married adolescent girls; and
• Decreased likelihood of worrying about being HIV-positive among married adolescent girls and partners, and increased uptake of HIV- testing among never pregnant married adolescent girls.

Lessons Learned

Radio campaigns built in synergy with multiple media channels can successfully be used to target hard-to- reach groups, such as married adolescent girls. When SMS information is reinforced through other channels of communication such as radio and IEC materials, they are more effective.

Conclusion

The combined use of this mHealth application with community health worker visitation, health information provision, and referrals, is an effective means of reinforcing RH/FP and HIV messages, and of increasing access to RH/FP and HIV information and services among married girls in rural settings.

PROJECT UPDATES

The project is still active. During the initial project period, it was learned anecdotally that a lot of the married adolescent girls that had been interviewed would have liked to have been in school. As a result, the project morphed into Ting’ Nyako Malo (meaning “Lift Girls Up”), a program focused on promoting school re-entry for out-of-school adolescent mothers (regardless of marital status), and drawing on Kenya’s school re-entry and national school health policies in the same geographic region.

A new radio program, which includes call-ins and SMS messaging, was developed for this purpose, and the project has been running from 2014 to date. While it was not a primary focus, the new program did touch on access to family planning for parenting girls who would like to return to school. For example, some of the parents interviewed as part of the interactive ratio program spoke about how, after their daughters became pregnant and had their babies, they went to the clinic, were advised to obtain family planning, and did so in order to be able to finish up their education without a repeat pregnancy. An additional component to the new project involves technical assistance by Kenya’s Ministry of Education at the national level to promote girls’ school re-entry, by using some of the project’s tested strategies.  

Ting’ Nyako Malo scaled beyond the original study/program context. The original Chakruok Interactive Radio Program context is now known as Homa Bay County. The radio program was used to foster community-level policy dialogue. A face-to-face dialogue approach with guided discussions was used to foster county-level dialogue with school heads. This latter approach has been replicated nationally. In collaboration with the ministry of education, Population Council used this approach to sensitize school heads nationally through the Kenya Primary School Heads Association (KEPSHA) and Kenya Secondary School Heads Association (KESSHA), which are annual national meetings of all school heads in the country.

Project Evaluation

In 2015, Population Council conducted a baseline study report in Homa Bay and Ndhiwa, subcounties of Homa Bay County, Kenya, involving the following data collection components: a household survey with out-of-school teenage girls (regardless of whether they had ever been pregnant or not), and teenage mothers and their household heads; and a school survey with secondary-school principals and students. The study objectives were to (1) foster an understanding of the current situation and context in regard to out-of-school teenage mothers and their potential support systems for school re-entry at the household and school levels in Homa Bay County; (2) clarify possible solutions for promoting school re-entry on the part of out-of-school girls, their families, and the education sector; and (3) provide a benchmark against which changes resulting from an intervention to promote school re-entry may be measured by the endline period.

Key findings from the baseline study include the following:

• Pregnancy happens early in the schooling career of most teenage girls.
• Pregnancy is often the critical incident that precedes school dropout by teenage mothers.
• Pregnancy often precipitates early marriage.
• Intimate partnerships with peers are important for understanding school pregnancy.
• School pregnancy rates are high.
• Community attitudes toward school continuation by pregnant learners or re-entry by parenting students are largely positive.
• Inconsistencies in the school and policy environments must be resolved to effectively promote school re-entry.
• Most out-of-school teenage mothers would like to go back to school someday and intend to do so.
• Financial constraints and child care are key barriers that prohibit school re-entry for teenage mothers.
• Awareness of policies that could facilitate school continuation or re-entry needs to be enhanced.
• Radio is an important means of conveying policy information to stakeholders in Homa Bay.

Findings suggest that a media campaign centered on radio programming would be context appropriate, and that such an avenue could be used to enhance awareness of relevant policies, as well as to garner widespread support for school re-entry by teenage mothers.

References/Resources

Original Case Study

Chi-Chi Undie, Harriet Birungi, Francis Obare, Ben Ochieng, Wilson Liambila, Erick Oweya, Ian Askew, Rob Burnet, Bridget Deacon, Aisha Mohamed. 2012. Expanding access to comprehensive Reproductive Health and HIV information and services for married adolescent girls in Nyanza Province. APHIA II OR Project in Kenya. Population Council: Nairobi, Kenya.

Project Updates

Undie, Chi-Chi, et al., “Education Sector Response to Early and Unintended Pregnancy: A Policy Dialogue in Homa Bay County, Kenya,” STEP UP Meeting Report (Nairobi: Population Council, December 2015), https://www.popcouncil.org/uploads/pdfs/2015STEPUP_EducSectorPolicyDialogue.pdf.

Undie, Chi-Chi, et al., “Expanding Access to Secondary School Education for Teenage Mothers in Kenya: A Baseline Study Report,” STEP UP Technical Report (Nairobi: Population Council, December 2015),  https://www.popcouncil.org/uploads/pdfs/2015STEPUP_EducTeenMothersKenya.pdf.

Undie, Chi-Chi, et al., “Final Evaluation Results: Expanding Access to Secondary School Education for Teenage Mothers in Homa Bay County,” 2020, https://www.popcouncil.org/uploads/pdfs/2020RH_Phase_I_Evaluation_Results_Kenya.pdf.

Undie, Chi-Chi, and Harriet Birungi, “Are School Principals ‘the Bad Guys’? Nuancing the narrative of school re‐entry policy implementation in Kenya.” Changing Social Norms to Universalize Girls’ Education in East Africa: Lessons from a Pilot Project (2016): 166. https://www.popcouncil.org/uploads/pdfs/2016RH_SchoolPrincipals_chapter.pdf.

“Chi-Chi Undie Interviewed on Teen Pregnancy and School Re-Entry in Kenya,” in Regional Education Learning Initiative (RELI) in Kenya and Well Made Strategy, podcast, July 2020,

https://www.popcouncil.org/research/chi-chi-undie-podcast-well-made-strategy-reli.

Population Council, “Expanding Access to Secondary School Education for Teenage Mothers in Kenya: A Baseline Study Report,”

https://www.popcouncil.org/research/expanding-access-to-secondary-school-education-for-teenage-mothers-in-kenya.

“Pregnant Girls, Young Mothers Barred from School in Africa,” Human Rights Watch, June 14, 2018. Video, 3:21, https://www.youtube.com/watch?v=FlV97ja5U0A&feature=youtu.be.