South Africa
November 2022 – December 2024
Summary
This case study presents Project Last Mile’s successful pilot in South Africa at the end of the COVID-19 pandemic. The pilot aimed to test an approach involving youth development organizations and role models in underserved areas to help increase youth engagement in health and wellness services. Through partnerships with USAID and local government, the pilot enlisted youth organizations and role models to boost health literacy and attendance at wellness events. The pilot received substantial engagement, with 524 young people attending the two wellness events where 1,333 health services were delivered. The pilot campaign also bolstered trust in healthcare providers and role models, highlighting how tailored strategies and collaborative campaign development can enhance youth engagement in health and wellness services.
Context
During the COVID-19 pandemic, Project Last Mile partnered with national ministries of health to support vaccine distribution and generate demand in nine countries through funding from The Coca-Cola Foundation and the United States Agency for International Development (USAID).
In South Africa, this support included building mass awareness in the general population about why, how, and where to get vaccinated. Then, as the pandemic and vaccine rollout evolved, Project Last Mile supported National and Provincial Departments of Health with targeted communication approaches, including pilots like this one, to reach specific population segments with low COVID-19 vaccine uptake.
The pilot was created to understand the best ways to engage hard-to-reach youth in two sub-districts of Cape Town (Khayelitsha and Mitchell’s Plain) by leveraging youth development organizations and role models in those areas. The aim was to share the learnings and insights gained from the pilot with USAID, the Western Cape Department of Health and Wellness (WCGHW), and implementing partners to help replicate and scale this approach in other areas of the province.
The intervention
Project Last Mile partnered with USAID and the WCGHW in two sub-districts – Khayelitsha and Mitchell’s Plain – to explore how to motivate young people to engage in health and wellness services, especially males aged 18-30, who were lagging in COVID-19 vaccination and healthcare engagement generally. In mid-2023, the COVID-19 pandemic was past its peak, and restrictions had dropped, resulting in a steep decline in interest in obtaining the COVID-19 vaccine.
Private sector models
Project Last Mile deployed an insights-based consumer marketing approach to identify and motivate disengaged young people. This included audience segmentation and profiling, and co-creating aspirational messaging with young people. The aim was to move beyond sharing health service information and inspire them to take a holistic view of their health. Project Last Mile used entertainment as a draw for wellness events, targeting young people. The wellness events included sports, games, and prizes to motivate participation.
Approach
From an extensive literature review on youth engagement and key informant interviews, Project Last Mile found that engaging with youth organizations in the target geographic areas could effectively reach an 18 to 30-year-old audience. The rationale was that youth organizations could offer a foundation of belonging and trust to encourage health and wellness engagement. Additionally, youth organizations are embedded in the community and could act as sustainable conduits to engage youth on health and wellness.
Project Last Mile conducted a landscape review of community-based organizations supporting youth development in two sub-districts of Western Cape. After confirming the selection criteria and engaging with leaders of the youth development organizations that matched these criteria, six organizations were selected to participate in the pilot. These organizations were chosen based on their use of mentorship, ability to offer a safe space for engagement, and alignment with the pilot campaign’s overarching goals.
The Project Last Mile team worked with leaders of these organizations to identify, recruit, and onboard 18 role models. These role models were chosen for their mentoring experience, communication skills, and eagerness to participate in the pilot. The team partnered with a creative agency to facilitate and co-create the campaign messaging, look and feel, and tactics. This involved conducting workshops with the role models and leaders of the youth development organizations to develop the copy and visual language. The team also engaged an events company to implement the wellness events.
Project Last Mile and its partners developed a toolkit for the role models to assist them with communicating important health and wellness topics to their peers, as well as to help encourage their community to attend the wellness events. The toolkit was a simple and concise how-to guide to assist the role models and youth organizations in executing the five-week pilot. It included items like playing cards with engaging Q&A scenarios for various health topics, posters, flyers, and digital assets to spread awareness. Wellness Day collateral was designed around the co-created branding of ‘Show Up For Your Health’, an insight derived from pre-campaign research and tested during co-creation workshops with the target audience. The collateral included banners, tablecloths, gazebos, lanyards, fence branding, and t-shirts.
Project Last Mile trained the role models, focusing on understanding health concepts, as well as how to deliver health messaging and motivate other young people to attend wellness events. In addition, the role models visited a government-owned health facility. They were hosted by health center management and health workers to build relationships, overcome anxieties about visiting health facilities, and educated about the services relevant to young people.
Project Last Mile and its partners delivered two wellness events designed to provide a fun and safe environment for young people to access health and wellness services while at the same time enjoying games and spontaneous dance classes. Services included COVID-19 vaccinations, mental health, and general health screenings provided by the WCGHW and partners such as Anova and DGMT.
To meet the learning goals of the pilot, Project Last Mile conducted pre-post surveys and qualitative research with community-based organization leadership, role models, and the target audience (community-based organization members).
Pilot results
Participation
The pilot reached 779 young people aged 18-30 surpassing the combined membership count of the six youth organizations.
Specifically:
- 460 youth members of participating youth organizations engaged in the pilot.
- 319 additional young people engaged with the campaign material online or on social channels.
Engagement
The wellness days were attended by 524 people, 50% of whom were under the age of 30.
85% of attendees heard about the wellness day from a role model or youth development leader.
Services delivered
1,333 services were delivered at the wellness events, averaging 2 to 3 services per person. The diversity of services underscored the pilot’s commitment to addressing various aspects of youth wellbeing through integrated health services.
- 86 HIV and sexual health screenings
- 61 COVID-19 vaccinations
- 541 general health screenings
- 170 mental health screenings
- 154 dental health screenings
“We are so pleased to see so many young men. Youth and adolescent interventions like this are often attended largely by the girls and young ladies. This was successful in getting boys to attend.”
– Dr Estelle Lawrence, Principal medical officer school, adolescent and youth health, Khayelitsha Eastern Substructure
Program resonance
Project Last Mile found that more than 80% of young people were comfortable discussing health issues with their role model and that the information shared by the role model was relevant and relatable.
They felt the message was inspiring, empathetic, and delivered by a trusted source.
Program outcomes
The services delivered at the wellness events reached young people who would not otherwise have sought out or had access to these services.
During the campaign, there was a 5% increase in trust in healthcare providers and a 20% increase in trust in influencers (presumed to be the youth models) among the youth participants.
Qualitative interviews revealed that participants had not previously received much information about health and were more open to receiving information about health following the campaign.
Partners expressed appreciation for several aspects of the intervention, including:
- The effectiveness of collaboration between government and service delivery partners and the potential for achieving shared goals.
- Recognizing the significance of engaging with local health service leadership and existing community structures to ensure continued support and sustainability of health interventions.
- Valuing a responsive approach, where their needs and feedback of the youth role models and leaders were actively listened to and incorporated into the campaign.
- Celebrating the intervention’s success in engaging a diverse audience, particularly noting increased participation from young people, particularly young males.
“To me, this is very important. I did have two friends who were not taking care of themselves. I saw them dying because they did not accept their status. They did not take medication. Now I understand how health is very important. I have now started knowing that I should go to the clinic every now and then.”
– Wellness day youth participant
Lessons
The pilot yielded lessons that can potentially be used more broadly to encourage youth engagement in health.
While the campaign was resource-intensive compared to other campaigns, such as mass communications approaches, the pilot successfully engaged an audience in these communities that the WCGHW previously struggled to engage through other approaches.
Key lessons from the pilot were:
Young people are uncertain about their future and have constantly shifting priorities, commitments, and demands. Health seeking behaviors are deprioritized, especially for the lowest income groups, such as those reached in this project. They are thus hard to reach and engage using traditional media channels.
Early engagement with young people on their terms can be a foundation for long-term healthy behaviors. Engagement is possible if healthcare services view young people as partners and not passive recipients of healthcare. The process of communication and engagement should be youth-tailored and, where possible, youth-led.
To engage and maintain a connection with young people, reach them where they feel a sense of belonging and psychological and physical safety. Youth organizations, non-profit organizations, and other social developmental institutions are good spaces to reach young people as they are already embedded with the communities and support issues that young people are interested in, thus creating a sustainable channel of engagement with the youth.
Role models within youth organizations can be trained to reach young people about healthcare. The program helped youth organizations and role models to understand the link between health and their own mission and activities, and their ownership of the project created trust and credibility with their members.
Differentiated models of care with multiple service offerings can improve access and enable positive health seeking behaviors. Young people are reluctant to access healthcare services at a health facility. The delivery of services outside the traditional health facility can provide a safe, non-judgmental environment for young people to explore health and wellness and make use of health and vaccination services. Ensuring that multiple services are offered in an integrated way (such as at a single event) helps to improve broader health literacy and prevention.
Co-creating campaign materials creates a strong sense of ownership and pride among youth. Campaign messaging, visuals, and tactics were co-created with the youth organizations and role models in workshops and training sessions, making them feel heard and valued and empowering them to lead health conversations with their peers.
Engaging youth organizations and role models must be done with respect and support. Youth organizations and role models become more efficient conduits of health communication when they feel recognized and trusted. However, they need to be empowered through training and support systems to ensure their knowledge of health issues is accurate and know how to handle difficult conversations.
