loveLife’s Mobile C onditional Incentive Programme: iloveLife

2. loveLife’s Mobile Conditional Incentive Programme:iloveLife 23 July 2014

3. Introduction to loveLife

4. loveLife • Driven by youth volunteers called groundBREAKERs and mpintshis • Footprint in South Africa: • 900 • sites • 8000 • schools • >300 • franchised community-based organisations • 532government clinics • 22 • Youth • Centres

5. Risk Construct Individual Social Structural • COERCION • PEER PRESSURE • LACK OF PARENTAL COMMUNICATION • EXPECTATIONS OF WOMANHOOD • MALE SENSE OF ENTITLEMENT • LOW SELF-ESTEEM • NO SENSE OF FUTURE • UNCERTAIN IDENTITY • POVERTY • LOW EDUCATION • MARGINALIZATION • INEQUALITY Helplessness in the face of challenges Sense of constrained choices Pressure to acquiesce Perception of scant opportunity HIGH RISK TOLERANCE EARLY SEXUAL DEBUT UNSAFE SEX MULTIPLE SEXUAL PARTNERS RISKY SEXUAL BEHAVIOUR Possible HIV INFECTION

6. loveLife Evidence

7. Rationale for iloveLife

8. HIV and Social Determinants • Two-year experiment in Zomba, Southern Malawi, using cash incentives in households with schoolgirls aged 13-22 Conditional cash transfer results: • Improve school attendance • Reduce sexual activity • Reduce teenage pregnancy • Reduce early marriage

9. Rationale • Study in Kenya2 incentivised visits to healthcare facilities • 117% increase in prenatal care services • 84% increase in HIV testing • 58% increase in follow-up visits to prenatal clinics • Similar approaches conducted in other countries: • Offered conditional cash, grocery vouchers, nutritional supplements, educational subsidies • Conditional reward successfully applied worldwide across education, social welfare, and health care with South Africa as a forerunner 2-The impact of conditional in-kind subsidies on preventative health behaviours: Evidence from Western Kenya. July 2005. PascalisDupas, EHESS-PSE.

10. Group identity formation around the concept of a “crew” or “posse. • Girls in crew affirm each other, reinforce positive and negative behaviours. • Sexually very assertive (e.g. “Foxy Chix”; “Pussy Gals”). • Celebration of femininity and group solidarity.

11. Rationale • Discovery Health (SA’s largest private health insurer) launched Vitality in 1998 • Incentive and reward based wellness program with statistically significant effects:3 • Lower costs per patient • Shorter hospital stays • Lower admission rates for engaged members • Lower chronic disease costs amongst engaged members 3-Discovery Vitality Journal: Reducing the cost of healthcare through lifestyle intervention. 2008

12. Underlying iloveLife Design Principles

13. Underlying iloveLife Design Principles

14. Audience demands ENGAGEMENT RECOGNITION REWARDS CONTENT ENTERTAINMENT STIMULATION INFORMATION SEAMLESS SYSTEMS

15. Programme Design

16. Introducing iloveLife Reduce new HIV infections among youth by 15% over 3 years Overall Goal

17. User Journey • Implemented on mobile phones: • Through USSDtechnology via subscription • Or sign up via ilovelife.mobi

18. Online and Real World Activities • On site / online activities include: • Reading, commenting on and sharing articles and videos • Taking part in online quizzes and polls • View memes such as bitstrips and images

19. Online and Real World Activities • Real world activities include: • Clinic visits • HIV status check ups • Participation in loveLife events games • Unique codes are generated for specific real world activities

20. Programme’s M&E

21. Expected Results Results loveLife contact centre and online-media services Increased sense of access to things young people Online Content-messages/interaction Incentives Reduced transactional sex relationships Increased access to Healthcare services (i.e. HCT, STI etc.) Reduced age differences in sexual Reduced HIV incidence among young people Reduced levels of school drop-out’s Increased self-esteem and positive self-image Increased sense of purpose among young people Increased awareness of risk Delayed sexual debut Increased school attendance Increased consistent condom use Increased number of young people who complete Grade 12 Increased uptake of VMMC services Increased condom use at first sex

22. Theory of Change Reduced HIV incidence in young people (12-19) Impact Suppressed viral load Delayed sexual debut Reduction of sexual partners Increased VMMC Increased condom use Behaviourchange (outcomes) Increased uptake of ART Reduced inter-generational and transactional sex Increased school attendance Increase VCT Increased sense of access to resources Increased SRHR knowledge Increased awareness of risk Changes in attitudes (e.g. shared responsibility) Increased self-efficacy to seek help Increased sense of purpose Increased self-esteem Predictors of behaviour (outputs) Provide links to opportunities Provide self-assessments Providing incentives for real world programme participation Providing incentives for participation in clinical committees and health talks Providing incentives for HCT and VMMC Provide special campaigns and competitions Provide forums and facilitate interactions between users Key Activities Providing incentives for online participation Provide online quizzes Providing incentives for school attendance and school performance Provide motivational messages and motivational talks Provide content on SRHR

23. Indicators at Output Level

24. Indicators at Outcome Level

25. Live Demonstration

26. Thank-you. Tel +27 (0)11 523 1000 Fax +27 (0)11 523 100148 wierdard west, wierdavalley, sandton, 2196P O Box 45 parklands 2121 south africatalk@lovelife.org.za www.lovelife.org.za