E2A Newsletter December 2017-January 2018

E2A to lead youth-friendly services assessment in Senegal

Working closely with Senegal’s Ministry of Health and Welfare, E2A will lead an in-depth assessment of youth-friendly services offered by the country’s public health system. Findings from the assessment will inform Senegal’s National Strategic Plan for Adolescent and Youth Sexual and Reproductive Health (AYSRH), resulting in recommendations to the government about how youth-friendly services can be made more conducive to youth needs. The assessment will be directed by E2A and implemented locally by the Global Research and Advocacy Group.

The assessment in Senegal is part of the portfolio of work E2A has engaged in with governments in sub-Saharan Africa to improve national AYSRH plans, and specifically, the way youth-friendly services are offered. From 2013-2014, E2A conducted a national assessment of youth-friendly services in Malawi, which continues to inform improvements to the national youth reproductive health and family planning services program.

E2A, in partnership with governments and other implementing partners in the West Africa region, has also conducted AYSRH workshops in Niger, Côte D’Ivoire, and Togo. The workshops, attended by government, civil society organizations, and implementing partners, are informing improvements to national AYSRH strategic plans in the three countries. During the workshops, Thinking Outside of the Separate Space, a youth-friendly services decision-making tool developed by E2A and Pathfinder International, was used.

The Senegal assessment will be conducted in Kaolack, Kédougou, Kolda, Matam, Saint-Louis, and Sédhiou, the six regions with the poorest AYSRH indicators.

The assessment will examine the multiple approaches to offering youth-friendly services currently employed by the government: stand-alone youth centers, youth spaces within health facilities, the mainstreaming of youth-friendly services in health facilities, mobile services for young people, incorporation of youth-friendly services curricula in schools, and community-based youth-friendly services. Findings will determine which of the approaches are most effective and any improvements to the most effective approaches that can make them better adapted to youth needs.

The assessment will include survey questionnaires and interviews with health facility management staff, community health workers, community leaders, service providers, clients, and young people. Questions will cover a variety of topics including: sexual and reproductive health/family planning counseling, contraceptive services, sexually-transmitted infection testing and treatment, gynecological consultations, and HIV counseling and testing. The assessment team will also review AYSRH statistics to assess the factors that influence uptake and utilization of youth-friendly services by youth. Focus groups with peer educators will generate recommendations and practical guidance for behavior change communication efforts.

Findings from the study are expected to be publicly available in October 2018.

New resources available on sustainability and scale-up of Population, Health and Environment interventions in the Lake Victoria Basin

Communities in and around the Lake Victoria Basin, in Kenya and Uganda, experience interconnected challenges, including dependence on diminishing natural resources, pervasive poverty, food insecurity, poor sexual and reproductive health outcomes, and inaccessible health services. To address these intertwined challenges and foster healthy communities, Pathfinder International has been advancing an integrated population, health and environment (PHE) initiative called Health of People and Environment-Lake Victoria Basin (HoPE-LVB) since 2011.

The HoPE-LVB experience is different from other PHE efforts, which have not necessarily had an explicit focus on scale-up. The project applied the ExpandNet/World Health Organization systematic scaling-up approach of Beginning with the end in mind to ensure successful institutionalization and expansion of the project. Through support from E2A and other partners, the project documented application of the systematic approach to scale-up. Documentation efforts have resulted in this peer-review journal article, “Applying ExpandNet’s Systematic Approach to Scaling Up in an Integrated Population, Health and Environment Project in East Africa,” published in Social Sciences, earlier this month.

E2A has also added two briefs to its website: The first brief provides lessons to implementers and donors on how institutionalization emerged as a critical pathway towards scale-up and sustainability of integrated programming. The second brief focuses on the strong advocacy component used by the project to ensure institutionalization and expansion of successfully tested approaches, particularly collaboration with the Lake Victoria Basin Commission as an institutional partner.

DRC Stories from the Field

Delivering contraception to women affected by conflict

 Julie Mbombo, 26, and mother of four, received her implant through Pathfinder's USAID/DRC-supported community-based family planning project

I remember when my husband married me, and I was only 14. My parents agreed to it. This is exactly the situation of thousands of teenage and young girls in rural health areas like Bilomba, because parents are not informed, said Julie Mbombo, a resident in DRC’s Kasai Central Province.

Julie works as a project champion for Pathfinder’s community-based family planning program, which is supported by the USAID/DRC mission through E2A. Julie sensitizes girls and women about sexual and reproductive health, including the benefits of family planning and delaying marriage and pregnancy.

In the last year and a half, Julie’s community, in Kasai Central Province, has moved from relative peace to instability, and many residents have fled. Through the community-based family planning project in four zones of the province, however, 112 community-based distributors, working closely with 42 nurses, continue to deliver family planning services to remaining residents and those who are in transit.

When Julie first became involved with the project and learned about family planning, she and her husband chose to use condoms. Recently, she received a Jadelle implant, which will prevent pregnancies for the next five years.

Offering long-term methods to women like Julie is especially important because conflict and political instability makes health services largely inaccessible. Many women who flee from their homes without family planning are forced to give birth in desperate situations, without health care or support.

To distribute family planning commodities in the province, Pathfinder uses ambulances, which can pass through security checkpoints without difficulty.

To ensure the populations can easily access clinical methods like injectables and long-acting contraceptive implants, even when they are far from a health center, the community-based family planning project organizes outreach events in communal spaces, like markets. At the outreach events, community-based distributors and nurses from nearby health centers work together to provide family planning services. Women like Julie can receive injectable contraceptives and implants from nurses who operate a temporary clinic during the outreach event.

Girls today still have the chance to follow the sensitization we are doing with the support of the community-based family planning project, and continue their education instead of becoming pregnant when they are 14, said Julie. I want my three daughters to finish high school.

E2A to co-chair new Community of Practice on Service Communication

In January, E2A was invited to co-chair a new “Service Communication” Community of Practice with the Johns Hopkins University Center of Communication Programs. The Community of Practice will meet quarterly to share and discuss ways to advance learning on Social and Behavior Change (SBC).

The group will discuss how to promote SBC best practices in areas including provider behavior skills, human centered design, and behavioral economics. Working groups may be formed within the Community of Practice for more in-depth discussions on these topics.

Members of the Community of Practice include: USAID, Jhpiego’s Maternal and Child Survival Program, Chemonics, Population Services International, Georgetown University’s Institute for Reproductive Health, Marie Stopes International, International Planned Parenthood Federation, Save the Children, ideas42, Population Council, EngenderHealth, and FHI360.