Girl Effect’s Chhaa Jaa | #MobileDoctor

Join the SCTG as we celebrate UHC Day to promote health for all. Throughout our 12 Days of UHC series, SCTG members and partners share insights and lessons from their organizations on how self-care is part of the solution to achieving our goal — build a safer and healthier future and health systems that serve and protect us all.

By Sowjanya Kanuri and Akanksha Malhautra, Girl Effect

In India, a country with a patient to doctor ratio of 1:1,445 (compared to the WHO recommendation of 1:1,000) and the fourth lowest health budget in the world, telemedicine is an attractive solution to addressing challenges of access to cost-effective, quality healthcare and helping India advance its universal health coverage (UHC)  goals. It took a global pandemic like COVID-19 for this innovation to really take off, but the lessons we are learning now can be applied long after the pandemic has ended. 

With 1.2 billion adolescents worldwide, and over 250 million in India, UHC is impossible without adequate consideration of the specific health needs of adolescents and young adults.  

In June 2019, Girl Effect launched Chhaa Jaa (a clarion call to “Go Forth and Shine”) – a digital youth brand that inspires and equips low-income adolescent girls (16 to 19 years old) with the skills and confidence to navigate their sexual and reproductive health – from getting the right information to seeking expert help when needed. Through video and social media content, a Facebook community (Bak Bak Gang) and a chatbot (Bol Behen) – Chhaa Jaa delivers messages on the importance of health-seeking behaviours in engaging and entertaining ways.

Digital self-care, and telemedicine in particular, has the potential to remove many of the barriers that young girls in India face (particularly those most vulnerable, and in settings where restrictive social and gender norms are deeply entrenched) when accessing health care services on the ground. This kind of innovation will be essential to ensure that we can deliver on the goals and commitments to UHC. 

Adolescent girls have limited agency to make decisions about their health or bodies – often having these decisions made by parents or partners, they face restricted mobility and/or lack the financial means to go to a health provider, and concerns about privacy and fear of judgement when they do further limit access. Many unmarried girls in India would be embarrassed to tell a doctor that they are sexually active, worried about social stigma or scared their parents would find out. For an adolescent girl, speaking to a doctor online about sensitive issues about her body, such as a missed period, a vaginal infection, or queries about sex and contraception, is likely to be more comfortable than walking into a clinic. COVID-19 has created an increased need and demand for digital self-care solutions, and the prolonged lockdown has left many girls unable to access health services. But, the need to reach adolescent girls will continue to persist long after this pandemic has come to an end. 

If we want to achieve the global goal of UHC by 2030, provide health for all, and protect everyone, that has to include affording better sexual and reproductive health for adolescent girls. By leveraging our expertise in social and behaviour change communication and building well-loved and trusted brands, Girl Effect plays a key role in generating demand for services by building girls’ self-motivation to take care of themselves and spurring them into action, in this case for their improved sexual and reproductive health. To equip girls with increased access to sexual and reproductive health information and products, we partner with youth-friendly health services providers. We aim to provide various options of providers and communication channels that includes self-care (e.g. telemedicine, direct to consumer (DTC)) and other options (e.g. on-ground clinics, pharmacy and retail, and community-based service delivery). At Girl Effect, we believe it’s key that we support girls so they can sustain positive health-seeking behaviours (rather than a one-time, one-off action), such as repeated service uptake and continuation of contraceptives to prevent unintended pregnancies and/or protect themselves against sexually transmitted infections.  

As an exciting step in this direction, Girl Effect partnered with Lybrate, one of India’s largest telemedicine providers, with more than 150,000 doctors registered on its platform. Through a digital marketing campaign on Chhaa Jaa’s social media channels, Girl Effect increased awareness about the benefits of telemedicine, particularly as a solution to the challenges of accessing in-person health services during the COVID-19 pandemic. To eliminate financial and digital payment barriers, we offered 500 free gynaecologist consultations on Lybrate via chat, voice or video to incentivise trial, and collected feedback from Chhaa Jaa users of the service to understand how we might better position this service for adolescent girls. The campaign used a variety of videos and posts to create awareness about the service and offer and connect girls to Lybrate.

We were also aware of the need to ensure that girls are adequately equipped to safely access third party services like Lybrate. We tried to ensure that the appropriate safeguards were in place. This included thorough due diligence of Lybrate, a detailed risk mapping exercise and identifying appropriate risk mitigation strategies. Through this exercise, we developed key messages we needed to communicate to girls so they understood how to access the available health services and to set expectations around the user experience (e.g. it may feel like a lot of steps but stick with it, doctors are not all alike and you can walk away if you feel uncomfortable).  We included these within every campaign asset – using popular Chhaa Jaa characters and through dedicated videos on online safety, as a part of every single social media post during the campaign and even within our website. 

A snapshot of the campaign

The campaign resulted in over 30,000 visits to our website (which acts as a directory of adolescent friendly services), and 715 click-throughs to third-party services including Lybrate. 

And most importantly, we have received encouraging feedback on Lybrate (and telemedicine, in general) from girls so far, 75% of whom said they would use the service again without the offer.

I will say this app is very useful, easy to use, secure and helpful.” 
In this we don’t have to speak face to face, so no fear of embarrassment.” 
This service is very good and it is beneficial to us and we can find out a lot about our health from this.” 

This campaign and pilot have been the first step towards learning more about how we can successfully and safely connect girls with digital self-care solutions as a way to ensure India reaches its UHC goals. We are encouraged by girls’ interest in accessing self-care services and are keen to co-create innovative partnership models, including with providers that haven’t traditionally seen this audience as commercially viable. These kinds of solutions will be vital to providing health for all and protecting everyone. We are excited to partner with other organizations to do more and learn more in this promising and important space as a way to achieve UHC!