How to increase citizen’s participation in the improvement of public services in Cape Verde? This was the challenge the Accelerator Lab Cabo Verde chose to tackle in its starting 100-days plan. In this text we present you our journey in the quest for setting a quick and easy to use feedback system that could engage relevant stakeholders, capture data and produce information to help public sector improve their services and policies.

Sensing…

So we’ve started our journey! The first challenge we’ve faced was how to narrow down the scope of our projet. Public services in general was to wide to tackle and we also needed to focus our target audience. To accomplish this, we’ve started internal consultations with CO portfolios in order to get a sense of which areas and/or services would be more promising to tap into as our first project, and use some of their experience and network to design a feasible initiative for the next 100 days ahead. We’ve also conducted two workshops, with potential partners, public sector, private sector representatives and NGO’s, to present more details the lab’s methodology and goals and help establish in more detail the targets for our project.

As a result of this process, we’ve learned that our country is in a demographic transition, in which 15 to 34 year old’s represent about 40% of the population and that significant economic and social challenges affects this portion of the population, such as unwanted pregnancies, sexually transmitted diseases, dating violence, gender-based violence, alcoholism, depression, migration, and cultural and technological changes, with implications on education, employment and health. We’ve also learned that a lack of interest and engagement of adolescents with health services might have been challenging services to devise new and different ways to approach and address the needs of this specific target group.

But how could we learn more on the personal, social and situational conditions of our adolescents? How could we use that information to help decision makers better understand adolescent behavior patterns regarding health and therefore improve policies and services provision? We thought that we could make a valuable contribute to this issue.

… Exploring

Next, we needed to identify and engage with relevant stakeholders in the adolescent health sector. Several interviews and workshops were then conducted. We went to health centers, schools, we met with the National Director of Health, the National Director of Education, the Focal points for Adolescent Health, Scholar Health and Mental Health National Programs, we’ve also spoken to the administrative services in health center and with the Government ICT agency to better understand existing health IT systems and integration possibilities for a feedback system. We’ve interviewed psychologists, social assistants and teachers in two schools.

As a result of this process, we’ve collected a number of materials, such as attendance forms and questionnaires in health centers, social services and mental health services, including a Child and Adolescent Health notebook from health services. We’ve learned from this process that basic care is still something that many adolescents is struggling with. Socio-economic conditions of many families challenges nutrition and mental health of many adolescents. We’ve also acknowledged that although significant progress in neonatal health, we didn’t reach the same success level of success in reducing adolescent pregnancy. The IDSR-III (2018) statistic bulletin of INE reported that 12% of girls from 15 to 19 years old have already had one child, and the proportion of those with 15 years old almost tripled since 2005. Institutional follow-up mechanisms between schools and health systems could be improved to bring greater benefits in the identification, attendance and follow-up of psychotherapeutic needs and nutritional deficit situations and help prevent many issues. Also, fragmented information and non-standardized data collection procedures between schools and health services does not help proper follow-up of adolescent health needs.

The solution!

After this consultation process, the solution envisioned with parties was to provide an integrated platform that could collect, treat and trace adolescent health data and produce visualization data products, such as reports and dashboard, to decision makers in order to enhance their knowledge on behavioral patterns, deficit situations and needs. This system should be accessible to professionals in health centers, and the information should be collected in health centers, in schools and communities. The system should also be able to integrate information given from the adolescents themselves.

In order to develop such a solution, an adolescent health questionnaire (questionnaire 1) was to be designed with the help of health professionals, in order to screen the information needed to help them in their activities, and a feedback mechanism developed to collect the data and feed it into this integrated information system that would help services respond more effectively to adolescent health needs identified.

The next step was to develop an MVP and test it in a given area including in one health center, one school and the resident community.

Challenges Faced and Lessons Learned

Defining the problem and finding the right balance of scope, methodologies and our ambitions for the project were very challenging. We needed to adapt to changing needs and requirements, revise our challenge statement and hypothesis many times, and finally consolidate our learning questions for the project later on in our journey

A significant issue we had to handle in the project was data protection and ethics. To be valuable to the services a health questionnaire was design for the adolescents in order to collect data that could help identify conditions and behavior patterns that could be increasing risks and vulnerabilities of this target group. Such a questionnaire included sensitive questions and needed to be ministered presential by trained personnel, posing data protection issues, especially considering an underaged population. This required a much more complex process than that we have anticipated. A dossier was compiled and submitted to the health ethics commission, but the timings for such procedures was not compatible with our time frame, nor we had it planned.

In March, the pandemic crisis broke up in the country and access to health services, schools and even the community, with social distancing, was not possible. The state of emergency was declared. At this point, we decided to conduct a small scale exercise in order to test the functionalities of the system we have developed so far. A second questionnaire that could be administered remotely was then developed, shifting the focus from sensitive personal health information to anonymous feedback evaluation of quality of services available for the adolescents in health centers and schools. An online campaign to engage adolescents in providing their opinions and suggestions was conducted and the data collected was used to sample the feedback channel created for the services. We’ve concluded that SMS broadcast is significantly effective in leveraging online responses, if a proper communication campaign is set in traditional media and social networks.

What’s Next?

Scaling opportunities for this project includes a large scale exercise that could guarantee the acquirement of the health data designed in questionnaire 1. It would be extremely helpfull for the services to access and systematize this information from the target group, especially if it integrates data from more sources, like those in health information systems and schools. Sampling conditions should be safeguarded. A census of adolescents recurring health centers during a certain period should be a good option. Data protection and ethic procedures should be planned in detail.

A second line of work could be to promote a new health data management policy including centralized and decentralized data, API interfaces for integration, user profile management and data management training plan for health and education professionals. Data integration form several sources is still a significant issue, challenging the monitoring and evaluation of cases and behaviors patterns. Institutional follow-up mechanisms between schools and health systems could be created to bring greater benefits in the identification, attendance and follow-up of psychotherapeutic needs and nutritional deficit situations.

Finally, complementary products, such as a permanent communication channel with adolescents or an online portal for adolescents could be a good way forward in creating new and innovative ways for health services to engage with adolescents and to create a relationship channel to talk and clarify doubts, enhancing the prevention part of the response.