Study design and participants
Between August and September 2019, prior to the implementation of the Yathu Yathu strategy, a census of all households was conducted in all 20 clusters. During the census, all enumerated AYP were offered a prevention points card (PPC). In zones randomly allocated to the Yathu Yathu trial arm, AYP were informed that they could use their PPC to collect points for accessing SRH services at the hub in their zone or the local health facility and that these points could be used to redeem rewards. In control zones, AYP were informed that they could use their PPC to collect points for accessing SRH services at the local health facility and that these points could be used to redeem rewards. In addition to incentivising service access, the PPC data were used to monitor service use and estimate service coverage [After completion of the census, AYP who were not in possession of a PPC could still access services at the hubs but were not added to the enumeration list. Inclusion on the enumeration list was restricted due to the inability to accurately verify whether the AYP resided in a control or intervention zone. As such, the AYP enumerated at the start of the study period formed a “closed cohort” of AYP, among whom study outcomes were measured using PPC data and through a cross-sectional “endline” survey.