Tsa Banana, Botswana

Social Marketing of Reproductive Health Services to Youth

By John Harris

Beulah Emig knew the Tsa Banana project was off to a good start when 12% of her total target population showed up at the project launch. Beulah, the 19-year-old coordinator of Population Services International (PSI) Botswana’s adolescent reproductive health project, was surprised to see that her audience contained 3,000 of the 25,000 13 to18 year-olds in the Botswana town of Lobatse.

"I had expected about 300 kids. Until that point we had done a lot of shows as part of our normal social marketing activities," Beulah said, "but this audience was the most vocal and active I had seen." A successful launch was imperative because Beulah’s project would need to produce measurable results in only eight months.

Tsa Banana—which means "For Adolescents" in Setswana—was a USAID-funded project to test the impact of youth-oriented social marketing techniques. The project ran from March 1995 to March 1996. The project commissioned baseline and follow-up knowledge, attitudes, beliefs and practices studies in Francistown (the control site) and Lobatse (the intervention site). Though the project ended in 1996, most of the components and strategies of Tsa Banana have continued in Botswana, and have been replicated in Zambia, Malawi, and Namibia.

Tsa Banana aimed to improve adolescent reproductive health in Lobatse by branding and promoting sources of reproductive health services. Twenty-eight places frequented by youth (such as clinics, shops, and game rooms) were identified and promoted as being a source of information and advice for teens on relationships, acquired immunodeficiency syndrome (AIDS), teen pregnancy, and sexually transmitted diseases (STDs). These youth outlets had expressed a willingness to participate in the project, and staff who worked at the outlets attended a half-day training workshop. Promotion efforts and materials were based on Tsa Banana’s core message: stay healthy with condoms and reproductive health services and advice from Tsa Banana outlets. Project staff made follow-up visits to the outlets to ensure that they were well-staffed and stocked with adequate written materials and other resources for youth.

The project branded each outlet with a logo that directly identified the outlet as youth-friendly. This was necessary because pre-testing had shown that young people felt, "clinics are meant for someone else, not me." It decided to use a modified version of the existing popular PSI condom brand, Lovers Plus, without directly mentioning the brand. The new logo used the same large green "plus" symbol, but with the words Tsa Banana inside. Pretests showed that audiences identified the logo as being "from the Lovers Plus people, but not the same thing as Lovers Plus."

The Tsa Banana project also employed other strategies to get educational messages out to youth. Peer education and promotion (PEP) sessions were 15-30 minute shows that entertained small audiences in schools and public places by dramatizing condom negotiation, holding contests based on audience knowledge of reproductive health topics, and answering audience questions. Initially, headmasters were reluctant to allow the PEP teams to perform at schools during school hours. The teams quickly earned the trust of headmasters, however, by adapting their shows for various age groups and by emphasizing the importance of knowing limits, asking for advice, seeking treatment and resisting peer pressure. By the end of the project, virtually every 13-18 year-old in Lobatse schools had seen an in-school show.

Live promotional shows attracted audiences of 500-3,500 adolescents, and used techniques and routines developed by PEP teams. Entertainment included local drama, dance, and music groups, along with contests and skits developed by PSI staff. Tsa Banana shows emphasized solutions rather than problems. The messages focused on how to "have fun," "stay healthy," and "get good advice." In the eight months between launch and evaluation, the project staged seven promotional shows. In order to ensure a high turnout at these shows, project staff placed posters and banners around town, made announcements at schools, played loud music on the day of the event, and drove around town with a bullhorn.

Radio shows also drew heavily from PEP experiences. PSI Botswana’s twice-weekly radio shows promoted the PEP and live promotional shows, but did not contain project messages per se so that the control site would not be affected. Typically, presenters would offer Tsa Banana publicity information such as, "Just for Lobatse, Tsa Banana will present another Hot Jam on June 8 at Peleng Community Center."

Supporting media, such as posters, brochures, and T-shirts helped generate excitement but were not as important as live media.

Despite its brief life span, evaluation showed that Tsa Banana had an overall positive impact. By October 1995, 68% of female and 71% of male adolescents in Lobatse had heard of the Tsa Banana project. As a result, their beliefs regarding AIDS and preventive behavior significantly improved. After the intervention, male adolescents were 1.5 times more likely than before to believe that people use condoms to avoid sexual risks and only .7 times as likely as before to believe it is hard to convince a partner to use a condom. Female adolescents interviewed were 3.4 times more likely to believe condom use prevents sexually transmitted diseases. Unfortunately, the project was unable to overcome shyness in obtaining condoms. It was also unable to overcome females’ belief that their partner will lose respect for them if they initiate condom use. Anecdotal evidence indicated that parents felt grateful that the project had communicated with youth about these issues.

The Tsa Banana project highlights the importance of utilizing youth in all aspects of development, implementation and management of projects aimed at youth. The success of this project is due, in large part, to the fact that youth contributed to the project at a variety of different levels, from the design of information, education and communication (IEC) campaigns to the overall management of project activities. PSI Botswana relied on experienced, young field promoters and coordinators to oversee and direct Tsa Banana project activities.

Tsa Banana shows us that the most valuable behavior change communication medium for adolescent audiences is a young person who can stand in front of a group of young people and say, "I have found my own solutions to the problems we all face," and then goes on to explain his or her version of the solutions.

John Harris, PSI Namibia

Mailing address: C/O PSI
1120 Nineteenth St., NW
Washington, DC 20036

USA

Telephone: 264-61- 244936

Fax: 264-61-244-937

E-mail: jah1@bigfoot.com

Web: www.psiwash.org