PARTNERSHIPS TO BRING ESSENTIAL SEXUAL
REPRODUCTIVE HEALTH INFORMATION AND SERVICES TO HARD-TO-REACH ADOLESCENTS AND YOUNG WOMEN
Sexual and reproductive health is fundamental to individuals, couples, and families and the social and economic development of communities and nations. Universal access to sexual and reproductive health (SRH) information and services is a human right and central to both individual and community health. In the wake of the COVID-19 pandemic and based on lessons learned from previous disease outbreaks — disruption of SRH services can cause individuals to feel disempowered and be exposed to preventable health risks. [WHO 2022]
In Ethiopia, youth account for over 50% of the population. Yet adolescent and young women are often overlooked when accessing SRH information and services. Women, particularly adolescent girls, and young women, lack agency in their reproductive health choices due to lack of access to information and services due to system-related barriers, gender norms, bias and judgment from health providers, and financial obstacles. For this reason, Marie Stopes Ethiopia and Population Services International Ethiopia came together to develop an innovative program that brings SRH information and high-quality services to rural adolescents and young women in the most hard-to-reach areas of Ethiopia. According to the 2019 Mini Ethiopian Demographic and Health Survey (mini-EDHS 2019), contraceptive use among currently
married women 15–19 years is 36.5%, with injectables being the most popular method used. According to a study conducted by BMC public health, urban adolescents have a greater chance (2.64 times) of accessing SRH services than rural adolescents. In addition, nearly 60% of Ethiopians live more than 10 kilometers (about 6.21 mi) from the nearest health facility in rural areas. Only half of those facilities are likely to have a trained health provider to provide SRH services.
Major factors contributing to poor access and uptake of SRH and contraceptive services and products in rural areas are:
- Limited awareness and relevance on Sexual Reproductive Health and Rights.
- Geographic distance to health facilities.
3. Lack of quality services at health facilities.
4. Provider bias when offering services to
adolescents and young women
5. Access to a range of contraceptive options.
Of the adolescent girls and women who take family planning, 90% use short-acting contraceptives (SAC), while only 10% use Long-Acting Reversible Contraception (LARC). Even though LARCs are highly effective, have minimal side effects, require less follow-up, and are low cost.
STRATEGIC PARTNERSHIP AND GOAL
Funded by Global Affairs Canada (GAC), PSI Ethiopia (PSI-E), and Marie Stopes International Ethiopia(MSIE), in partnership with the Ministry of Health (MOH), launched a program, Owning their Future (OTF) or “ነገን በራሴ” that aims to transform harmful gender norms and provides adolescent girls and young women access to SRH information and quality services. Owning the Future or “ነገን በራሴ” project. The Owning their Future project is a four-year project that aims to empower women and girls to make informed choices about their sexual and reproductive health and rights (SRHR). The project has an ambitious goal to reach 500,000 young girls and women in 39 districts in different regions of rural, hard-to-reach communities with SRHR and contraceptive services including LARCs.
PSI Ethiopia’s role in this project is to create demand for family planning and SRH services by developing innovative client-centered interventions using human-centered design. At the same time, MSI offers high-quality SRH services through its mobile outreach team of providers. PSI and MSI/Ethiopia teams plan and work together to ensure that adolescent girls and young women in the hardest-to-reach rural areas can access essential SRH information and services.
INNOVATIVE DEMAND GENERATION APPROACHES
One of the main components of the OTF project PSI’s uses to generate demand for family planning services is an intervention called Smart Start. Smart Start was developed through PSI/E’s flagship project Adolescents360. Smart Start was created using human-centered design, cultural anthropology, and adolescent developmental science. Smart Start uses financial planning as an entry point to engage young married couples in rural Ethiopia in planning their futures and reaching financial stability, helping couples understand how delayed first birth and spaced pregnancies facilitate improved savings and capital to pursue their shared life goals. Smart Start Navigators (peer-educators) and Health Extension Workers (HEWs) are trained to host conversations about financial planning and HEWs provide contraceptive services in an approachable way to rural, married girls and their husbands, using a visual discussion guide that will soon be available digitally.
Building on PSI/Ethiopia’s expertise in Human-Centered Design, to adapt Smart Start counselling and service delivery to include Safe Abortion (SA) and Post Abortion Care (PAC) messaging. Interventions are currently in the pilot phase.
HOW DOES SMART START WORK?
To implement Smart Start, PSI/E’s Adolescent Health Officers, who have a clinical background and are based in the districts where OTF is implemented, work closely with Health Extension Workers and key stakeholders to determine the number of adolescent girls and young women in the community. A community kebele kick-off meeting is held to introduce Smart Start and to discuss SRH issues. This meeting is intended to create community buy-in and support. HEWs and Smart Start Navigators Orient Women Development Army members (WDAs), client champions, and male gatekeepers on how to mobilize girls and young women for Smart Start Sessions. Once adolescent girls are mobilized, they receive Smart Start counseling from Smart Start Navigators. The latter then refers them to the HEW for further family planning counseling and service provision. Adolescent Health Officers coordinate activities and mobilization of girls closely with MSI and referrals for SRH services are made to MSI’s mobile outreach services. Once there is a minimum of 20 referrals, MSI sends their outreach team to the Health Post to provide services. Services for short-term family planning methods are referred to the Health Post.
MOBILE OUTREACH MODEL
MSIE uses a mobile outreach model to deliver high-quality comprehensive family planning, safe abortion care, and post-abortion care services. “The mobile outreach program has succeeded compared to 37 other outreach programs in Africa.” From the Interview with an MSI Stakeholder-
The Mobile Outreach Units are comprised of a highly trained clinical team, including a health officer, a nurse, and a driver who also registers the clients. This team travels in a four-wheel-drive vehicle that is stocked with family planning commodities, infection prevention supplies, and medical equipment to provide SRH services. The outreach team sets up a space in the Health Post to deliver SRH services. Services are provided by MSE’s clinical team; however, they work closely with HEWs at the facility to strengthen their capacity in SRH service provision. Outreach teams strictly adhere to clinical quality guidelines developed by MSI’s global Medical Development Team. Under this program, all mobile outreach staff members are trained in youth-friendly service delivery, emphasizing informed choice, confidentiality, and non-judgment. Outreach services are offered free of charge, removing costs often cited as a critical barrier to uptake of FP by adolescents, especially in rural and hard-to-reach communities.
EARLY RESULTS ARE PROMISING
Early results from counseling and family planning services from April 2021-March2022.
• The OTF project has reached a total of 60,351 number (22% of the overall project plan and 94% of its annual plan) of adolescent girls and young women with comprehensive SRHR counseling in 290 Kebeles from 38 districts in Sidama, SNNP, Southwest, and Oromia Regions.
• 13,004 clients were referred by PSI to MSE mobile outreach and got services.
• 68,209 family planning services were provided to all adolescent girls and women between 15–49 years; of which 36,868 were adolescent girls and young women between 15–24 years old.
• Among all 68209 FP clients, 67,669 were LARC clients, and 471 received Permanent family planning services
• 457 clients received SA/PAC services and of which 332 chose a family planning method after safe abortion services.
The OTF project managed to address misconceptions, increase knowledge gaps on SRH and increase the uptake of LARC.
Furthermore, OTF community-based interventions breakdown down traditional and cultural barriers within the community by creating awareness, providing counseling services, and capacity-building training to health professionals.
SUSTAINABILITY AND FUTURE OUTLOOK
Through the OTF project, PSI-E and MSIE have developed a sustainable approach by providing local health professionals with the necessary tools and capacity-building activities to reach rural and underserved communities with SRH and FP services and products.
As a result, these health professionals will become equipped with the skills necessary to operate under the supervision of regional and woreda health bureaus after the project cycle ends.
In the meantime, PSI-E and MSI will strengthen their partnership to meet their final goal of reaching 500,000 young girls and women in 39 districts in different regions of rural, hard-to-reach communities with SRHR and contraceptive services.
