Innovative Demand Creation for VMMC in

Zambia

SOCIETY FOR FAMILY HEALTH Dr. Albert Machinda, Project Director

QualitativeResults:JourneyMapping

• 2years3monthsfromawarenesstocircumcision

• MajordropoffduetoCognitivedissonance

• 3Strategiestoreducedissonance:

ü Decreasenegativeneartermconsequences

ü Increaseneartermbenefits

ü Compresstime

94%Aware 34%Circumcise

11%Advocate

SOCIALLYSUPPORTEDBELIEVERS

Base:alluncircumcisedmen,n=1189

SELF-RELIANTBELIEVERS

FRIENDSDRIVENHESITANTS

INDIFFERENTREJECTERS

SCAREDREJECTERS

KNOWLEDGEABLEHESITANTS

TRADITIONALBELIEVERS

17%

27% 6%

11%

19%

9%

10%

Moderatepotential(11%ofuncircumcisedmen),buthighcommitmentandlikelihoodtoadvocatetowideaudience;needtoovercomesomedissonanceissue.

Moderatepotential(9%),buteasyconversiontoactionandhighlylikelytoactasadvocatesforfriendsandtosomeextentothermen.

Moderatepotential(10%),butthekeybarrierisconcerninsafetywhichreducemotivation– increaseoftheircommitmentisrelativelyeasybyaddressingtheirissues.

Largepotential(20%),butratherlowmotivationandneedinadditionalassuranceinneedofVMMC.Butcanbeeasilyconvertedbystrongadvocacyaroundthem.

Largepotential(17%)butlowmotivationandstrongconcerns,includingfearsandembarrassment–needalotofsupport.

Largepotential(27%),buthardtocrack;absenceofmotivationandalmostnoconcernsorfears,butcouldbereachedviaadvocatesinthecommunity.

Smallpotential(6%),noneedinsupport;haveveryhighcommitmentdrivenbytradition.

SEGMENTPRIORITIZATION:SEVENSEGMENTS

FROMDATATODESIGN

• Prioritizationofsegments• WorkshopforInsights• Designtailoredapproaches• AdaptTypingTool

SITUATIONAL ANALYSIS

5

STEP 1: SEGMENT PRIORITIZATION: CRITERIA BY ALL SEGMENTS

HUMANCENTEREDDESIGNAPPROACH

Hygiene:HeneedstohearaboutthehygienebenefitsofVMMC butalsotounderstandexactlyhowtheyareachieved.He’sskepticalaboutthecleanlinessaspectanddoesn’tunderstandthelinkbetweenhygieneandreducedinfections.Showingamodelofforeskin,andexplainingabouthowtheexposedskiniseasiertowashhelps.Mentionofwomenhereembarrassesthem.

Riskreduction:Heneedstounderstandthemeaningof60%protection,buttounderstandtherisktheyalsoneedbasicinformationonwhatanSTI is.It’simportantnottooverwhelmhim,asthisisanewconcept,buttogiveenoughbasicinformationtoappreciateriskreduction.

PainManagement:Hewantstoknowthatthepainisbearable.

Healing&Aftercare:Hewantsverydetailedinformationonwhattodotocareforhimselfafter,eventothelevelofwhattemperatureofwatertodrinktostayhydrated.Sincehe’slessinformedaboutsexhealsoneedstoknowwhyamancan’thaveitforsixweeks.

Popularity:ItisbesttoemphasizethattheMOH approvesofVMMC enoughtowantittobefree.

NationalPride:MOH approvesofVMMC andheisbeingaresponsiblemanbyhelpingreachanAIDSfreegeneration.

WhatdoesMr.Greenneedtohear:

POPULARITYPAINMANAGEMENTRISKREDUCTION

NATIONALPRIDE

FRIENDSDRIVENHESITANTS:MR.GREEN

HEALING&AFTERCAREHYGIENE

MostRelevantIPC Tools:60%Jar:KeepitbasicPain-o-meter:EmphasisonhealingHygieneMessaging:PenisModelBuddysystem:Chancetojoin

ValueStatement:“NowthatIknowhowVMMCworkstokeepmecleanandhealthy,whywouldn’tIwanttodotheresponsiblething?”

SITUATIONAL ANALYSIS

PROCEDUREWALKTHROUGH

TRUEORFALSEWHEEL SEXWHEEL BUDDYSYSTEM

60%JAR VIPWAITINGROOM PAIN-O-METER

HCD APPROACH: PRE-TESTING AND PROTOTYPING

HYBRID IPC PILOT DESIGNTAILOREDAPPROACHES- JOBAIDSPERSEGMENT

HYBRID IPC PILOT

Pilotednewapproach• 6-monthpilot,August2016- February2017• 5-daytrainingofhealthpromoters

DEMANDCREATIONPILOT: MEASUREMENT&PHASE1PILOTRESULTS

Zambia VMMC Program PilotIndicators

Project Outcomes Efficiency (increasedconversionrate)andeffectiveness(increasedMCs)

Programmatic Indicators Client age distribution,HPproductivity,effectiveIPCformat(groupsize)andsetting(locationofclients)

SITUATIONAL ANALYSIS

358

301

148

212

100

Avg.ReceivedFullIntervention/HP

Avg.AppointmentBooked/HP Avg.ActualMCs/HP

PILOTFINDINGS:JOURNEYCASCADE

INTENT

ANTICIPATE

182

1631

1042426

77 44

412

4146

2327

1104

170 88

10-14 15-19 20-24 25-29 30-34 35ANDABOVE

ConversionrateofClientsReachedbyAgeGroupAug2016– Feb2017(n=6926)

91% ofclientscircumcisedbetween15-29yearsduringpilotperiod

44%

39%

45%

39%

52% 33%

Circumcised ClientsReceivedFullIntervention

PILOTFINDINGS:ClientConversationRatebyAgeGroup,Aug-Feb2017(n=8,227)

39%

756536 504

820

272 311 202

1698

1099 1091

1394

526720

398

45% 49% 46% 59% 52% 43% 51%

PILOTFINDINGS:VMMCBookedvs.Actual,AllSegments(n=6,926)

SITUATIONAL ANALYSIS

1.Datadeliverymatters.Presentation,user-friendlinesskeyconsiderations.

2.Mustalignoutreachstructure/communicationchannelswithsegmentationapproach.Tailoringiskey!

3.Jobrequirementsmaychangeandextratraining/timemaybenecessary

4.M&Esystemupdatesmayberequired;nearreal-timedataextremelybeneficial

CHALLENGES & LESSONS LEARNED