Outcomes of the TENA IVR service impact evaluation in Ethiopia

For the last five months, Georgie Bouwknecht, Global Health student at the VU University Amsterdam, did her internship at Health[e]Foundation, during which she conducted a mixed methods study on the TENA IVR service implemented in Ethiopia in collaboration with the Ethiopian Midwives Association (EMwA) and Viamo. TENA has been developed to provide health information on topics related to the COVID-19 pandemic such as prevention and treatment of COVID-19; maternal health during the pandemic; sexual and reproductive health during the pandemic; or about what to do when experiencing domestic or gender-based violence and/or mental health problems as a consequence of the pandemic.

This research project aimed to identify the usage of TENA as well as the barriers and facilitators felt by TENA users, particularly focusing on differences in gender. Statistical analysis of TENA usage data was complemented by ten semi-structured interviews with a diverse group of TENA users in order to understand the barriers, facilitators, usage, perceptions, and knowledge gain felt by TENA users.

Interviews with users revealed that most of them had not experienced many barriers to TENA usage, and barriers that were faced were linked to external factors, such as poor electricity and network connectivity. Additionally, there was no difference reported in the barriers women faced compared to men. Many built-in characteristics of the TENA service were recognised by users as facilitators, most notably the content included, the language options and ease-of-use of TENA, and the trust they had in the service, considering its link to EMwA.

TENA use resulted in knowledge gain in the topics of prevention and treatment of COVID-19 and maternal health for all users. Practically, this means that following TENA use, more people understood the benefits of wearing a face mask in protecting against COVID-19 and that more antenatal care visits are necessary to ensure a healthy pregnancy. Aside from knowledge gain, TENA use also promoted behaviour changes among the interview sample, as shown in the quotes below.

“I develop[ed] a behaviour of sharing information for other people. Previously, I didn’t have any experience or friend to share, even if I have received training, I didn’t share this information. But, from the TENA mobile I tried to share all information for all my friends and other individuals” – a female participant

“Most of the pregnant women came to this clinical area on term, on term. So, they prepared a mini conference to educate women or females about ANC follow-up.” – a female participant

These quotes demonstrate the benefits of TENA not only to an individual in terms of personal growth, but also to whole communities in terms of health outcomes and health knowledge. In fact, the data showed a difference in the modus of information-sharing between men and women; men would share information preferably in a one-on-one setting while women were more likely to involve multiple persons at once. The users themselves recognised how important and beneficial TENA was to their communities and called for TENA to be continued and expanded in order to promote health changes to more people in more areas.

Overall, the results indicate the hugely positive impact TENA has had on its users. This research has not only demonstrated the remarkable changes TENA has initiated, but also lays the groundwork for considerations to make when implementing similar projects in the future.

Further reading on TENA: