E2A Newsletter June-July 2018
Responding to E2A Study Findings, Kenyatta University Makes Enhancements to Youth-Friendly Services Program
Peer counselors and youth-friendly service providers, Kenyatta University
Over the past two years, Kenyatta University’s youth-friendly services (YFS) program on its main Nairobi campus has made several improvements in response to recommendations of a study conducted by the Evidence to Action (E2A) Project and Pathfinder Kenya. The study provided fresh insights on how to strengthen the existing program, which was established more than 30 years ago.
The study, conducted from 2015 to 2016, gathered data on the current sexual and reproductive health (SRH) situation of students and the extent to which their SRH needs are being met by the YFS program.
E2A and Pathfinder Kenya followed up with administrators, including the Dean of Students, YFS providers, campus-based community health workers, and peer leaders from the university’s main Nairobi campus in April 2018. This group described how evidence from the study has been used, and how the E2A recommendations have been applied.
This video captures excerpts from the discussion in April 2018.
The most notable changes mentioned by the group are listed below.
- Allocation of KShs 100,000 annually by the Kenyatta University Student Association (KUSA) to support activities of peer counselors
KUSA is a prominent voice for student priorities on campus. E2A had recommended that KUSA’s youth leaders be more active partners to the YFS program. KUSA, with approval from university administration, decided to include Kshs 100,000 in its annual budget to support the YFS program. This money supports activities that have been driving awareness of SRH issues and referral to YFS on campus. Activities include talk shows that address pertinent SRH topics, and outreach and in-reaches to on- and off-campus students.
“We are the center of all of this,” said Benjamin Ochieng Juma, current chair of KU’s peer counselors. “All students pay a fee in their tuition to support KUSA, so in a sense, the student body has given its money to itself.”
- Allocation of an office at Kenyatta University’s Student Business Center for YFS and monthly in-reaches on campus, and allocation of resource room for peer counseling services at the Directorate of University Health Services
Although global evidence shows that a separate space for provision of YFS does not always drive increased access to SRH services among youth, perceptions gathered through interviews with students and providers conveyed that many students do not use SRH services on campus where they have been mainstreamed for fear of being seen by fellow students, faculty, and administrators. Kenyatta University allocated a resource room for confidential peer counseling at the Directorate of University Health Services. Additionally, at the business center, students can now receive the following SRH services:
- Screenings for cervical cancer and sexually transmitted infections
- Provision of contraceptives
- SRH information and counseling from peer counselors with referrals to on-campus student health services
This new space at the Business Center was partially supported by a local NGO and Marie Stopes International.
- Tripling the number of peer counselors operating on the Nairobi campus
Kenyatta University, made up of nine campuses and more than 80,000 students, now has one of the largest student bodies in Africa—25,000 students attend the Nairobi campus alone. Through support from the Dean’s Office/Directorate of Student Affairs and the Female Health Company, 100 additional peer counselors have been trained on the Nairobi campus since E2A conducted the study, bringing the total number to 150.
- Appointment of new management and coordination positions within the YFS program
Findings from the E2A study pushed Kenyatta University to rethink critical program elements—including management structures. The first operational change to increase capacity of the program was creation of new posts: a YFS program coordinator and a program director. Previously, the youth-friendly clinic in-charge served as a de facto coordinator and the director of health services for the entire university was the director of the YFS program. Acknowledging continuous growth in student SRH needs, the current program coordinator is mentoring a nurse at one of the campus clinics to serve as a second YFS coordinator.
- Targeting first-year students with SRH information and referral to YFS
The E2A study resoundingly found first-year students to be the most vulnerable among the student body to SRH challenges and problems. During orientations in May and September 2017 and at their hostels, peer counselors have talked to first-years about contraceptives and where to access YFS on campus. Each peer counselor is tasked with reaching out to 100 first-years initially and then following up with targeted text messages.
“Students are minors when they come to campus – 16 or 17 years old. The parents hand them over to you and these kids have to navigate adolescence, education. They are coming in with a lot of freedom and they are supposed to manage themselves,” said Dr. Charles Magoma, Kenya University’s Head of the Directorate of Student Affairs/Dean of Students. “This ‘sexual and reproductive health space’ is unique. It can save or destroy [student] lives.”
One Mother at a Time: E2A and the Saving Mothers Giving Life Initiative in Cross River State, Nigeria
Young mother and baby, Cross River State
Over the past two years, the Saving Mothers, Giving Life (SMGL) Initiative in Cross River State (CRS), Nigeria, has enabled 25,000 women to deliver their babies with a skilled provider at a health facility, and 7,200 women receiving postpartum and postabortion care services to adopt a contraceptive for the first time.
E2A and Pathfinder International Nigeria have worked with SMGL to ensure pregnant women in all 18 Local Government Areas of CRS can access delivery services—including emergency obstetric care—within two hours from their homes. According to the World Health Organization, two hours is the maximum amount of time a woman with an obstetric emergency cam travel to receive emergency care without risking her life or the life of her baby. All of these women receive postpartum family planning services after delivery.
The SMGL interventions in CRS are based on SMGL interventions piloted in Uganda and Zambia that resulted in a 35 percent decline in maternal mortality from childbirth at SMGL-supported facilities.
Cluster approach to life-saving care
In CRS, E2A and Pathfinder used GIS mapping to form “clusters” of facilities that would be supported by SMGL. Each cluster is made up of one district hospital and three primary healthcare centers. Primary healthcare centers offer antenatal care, postnatal care, and delivery services, and referrals to the district hospital for complications during pregnancy, labor and delivery. There are currently 10 clusters, for a total of 97 SMGL-supported facilities (72 public, 20 private, and 5 faith-based facilities) in the state.
“The cluster approach we employed has resulted in enhanced coverage of essential maternal and reproductive health services within a two-hour travel time axis,” said Dr. Farouk Jega, Pathfinder’s Country Director in Nigeria. “This has resulted in significant reductions in both maternal and newborn deaths, since birth complications from communities and lower-level health centers can now get to district hospitals and receive the emergency care to save their lives.”
Through SMGL in CRS, more than 1,300 medical officers, nurses, midwives, and Community Health Extension Workers have been trained to offer mothers life-saving interventions.
Reaching first-time parents
Unlike SMGL in Uganda and Zambia, E2A added a unique element to the SMGL program in CRS: interventions for reaching first-time parents with essential information and services focused on family planning and maternal and newborn healthcare. This component has helped the initiative to achieve statewide coverage of family planning services, greatly boosting demand for contraception.
At a recent event hosted by the Center for Strategic and International Studies (CSIS), where results from SMGL in Uganda and Zambia were disseminated, Dr. Inyang Asibong, the Commissioner for Health of CRS, touched on the value of E2A’s first-time parent interventions, particularly the focus on engaging men.
“In the communities where we engage the men, we get better results. We start early in the teenager’s head and move right down the family line,” she said. “We try to even encourage them to encourage their wives to go for antenatal care or even bring their wives for antenatal care.”
Dr. Farouk Jega, Country Director, Pathfinder/Nigeria (left) and Dr. Inyang Asibong, Commissioner for Health, Cross River State, Nigeria (right) at the CSIS event in June.
Sustainability of life-saving care
Dr. Asibong noted that SMGL in CRS will close next year but spoke optimistically about sustainability.
“We are trying to work on a sustainability program now, so we will not be too heartbroken, and it will not be too sudden for us by the time the project ends next year,” she said.
“I am very optimistic because we already have the buy-in of the government and the community of stakeholders,” she continued. “They have already seen the results. With these results, they wouldn’t want to go back to the way that things were before.”
SMGL is a partnership between the public, private, and NGO sectors. Partners include: Centers for Disease Control and Prevention, United States Agency for International Development, United States Department of Defense, Peace Corps, Office of the US Global AIDS Coordinator, Merck for Mothers, American College of Obstetricians and Gynecologists, Every Mother Counts, Government of Norway, Project C.U.R.E, Government of Uganda, and Government of Nigeria.
The SMGL program in CRS will continue until September 30, 2019
E2A’s Latest Tool Strengthens Family Planning and Adolescent and Youth Sexual and Reproductive Health Training for Nurses and Midwives
Juliet Zawedde, reproductive health teacher with Kibuli School of Nursing in Uganda
The Evidence to Action (E2A) Project has developed a suite of adapted materials, the Training Resource Package (TRP) for Pre-Service Education (PSE) in Family Planning (FP) and Adolescent and Youth Sexual and Reproductive Health (AYSRH), for use during pre-service education of nurses and midwives. The TRP for PSE in FP and AYSRH contains curriculum components and resources that can be used to design, implement, and evaluate training. The entire adapted package, as elaborated in the figure below, ensures up-to-date training on FP and AYSRH within pre-service nursing and midwifery education.
Juliet Zawedde, a reproductive health teacher with Kibuli School of Nursing in Uganda, blogged about her use of the adapted materials.
E2A’s TRP for PSE in FP and AYSRH is adapted from the Training Resource Package for Family Planning (TRP), developed in 2012 by the World Health Organization, the United States Agency for International Development, and the United Nations Population Fund. In October 2012, the TRP was officially launched at the International Federation of Gynecology and Obstetrics Congress, and uploaded on https://www.fptraining.org/ and K4Health. Over the next several years, E2A continued to disseminate the TRP during country, regional, and global events.
The purpose of the materials created and adapted by E2A is to harmonize and strengthen the FP and AYSRH training topics for pre-service nursing and midwifery education through application of evidence-based tools and in line with countries’ pre-service and FP policies and guidelines. It is designed to actively involve students in the learning process, and strengthen the ability of the health workforce to provide comprehensive, quality FP services.
The entire TRP for Pre-Service Education in FP and AYSRH can be accessed by clicking here.