E2A Newsletter November December 2016

Read this newsletter in French: Bulletin-E2A-Nov-Dec-bonnes-pratiques-SSRAJ-Afrique-Ouest

How E2A is Advancing AYSRHR Best Practices in Francophone West Africa

Nafissa Boubacar, 16 ans, mariée, sans enfant, du village de Hogole (Bougoum)

Photo Credit: Pathfinder International

Girls and young women in West Africa continue to give birth at a higher rate than any other place in the world. Without widespread access to adequate sexual and reproductive health (SRH) information and services that include a full array of contraceptives, they too often become mothers at an early age. And after their first child, many continue to have closely spaced, subsequent births despite their wish to space future pregnancies. Many of their pregnancies are therefore unintended—often forcing them to forgo education, employment, independence, and economic resilience to be full-time mothers, or, in some cases, to seek abortions in unsafe conditions. In addition to early marriage and early pregnancy, young women and girls are prone to sexual assault and gender-based violence, and all youth—irrespective of their gender—are at risk of contracting HIV and other sexually transmitted infections.

Since 2013, E2A has been focusing on addressing the SRH needs of youth in West Africa to curb the high rate of unintended pregnancies and empower youth to make healthy decisions about their SRH that will, in turn, award them a brighter future. This newsletter describes E2A’s ongoing efforts to improve adolescent and youth sexual and reproductive health and rights (AYSRHR) in West Africa by working with local, national, regional, and global partners.

Where it all started: policy work in Guinea and a regional meeting in Dakar

In 2013, E2A supported Guinea’s Ministry of Health with developing its first AYSRH strategic plan. While working with Guinea, E2A realized that other West African countries also needed support to improve AYSRHR. In January 2014, E2A, with Pathfinder International and the International Planned Parenthood Federation, therefore held a regional meeting for Francophone West African countries in Dakar, Senegal. The meeting fostered knowledge, collaboration, and a commitment among governments to prioritizing and improving AYSRHR across Francophone West Africa. At the meeting, representatives from the nine Ouagadougou Partnership countries met with partners and donors to create roadmaps for accelerating youth programming within the scope of the action plans they developed previously at the 2011 "Population, Development, and Family Planning in West Africa: An Urgency for Action" conference in Ouagadougou, Burkina Faso. These action plans laid the foundation for current Costed Implementation Plans and included the selection of best practices for introduction or scale-up.

Read the report from the regional meeting here.

Technical assistance to Governments of Niger, Togo, and Côte D’Ivoire

Since the regional meeting in 2014, E2A has worked with several West African governments to build on country plans developed under the Ouagadougou Partnership and FP2020.

University Leadership for Change in Niger

E2A led the University Leadership for Change (ULC) Program, from April 2014 to June 2016, in partnership with Niger’s ministries of health and higher education and Abdou Moumouni University in Niamey. The program enabled students and community youth in Niger to access family planning services for the first time, reaching almost 8,000 university students at Abdou Moumouni and their community-based peers (10-24 years) through a comprehensive approach to behavior change that engaged student peer leaders to facilitate behavior-change activities. The program also introduced contraceptive services for the first time at the university health center and built the capacity of health facility staff to provide youth-friendly services.  Students involved in the program have created a youth-led NGO on their own initiative to continue the ULC approach beyond the lifespan of the program, and promising results of ULC have motivated the Government of Niger and partners to plan for scale-up to three additional campuses in Tahoua, Maradi, and Zinder.

As a part of ULC, E2A also launched a new social and behavior change monitoring and decision-making tool, the “Pathways to Change Dashboard,” which summarizes the barriers and facilitators to SRH identified by young people. It is easily searchable and provides evidence that can be used for monitoring social and behavior change activities, programmatic decision-making, and strengthening AYSRH interventions. The dashboard is one of several social and behavior change tools developed by ULC, which also include three behavior change films that were used as part of the project approach.

Read more about ULC (English, French).

National AYSRH Workshops and Strategic Planning in Niger, Togo, and Côte D’Ivoire

Niger: As follow-up to the 2014 regional AYSRH meeting, E2A supported the Niger Ministry of Public Health (MOPH) to conduct a workshop in Niamey on AYSRH best practices in March 2015. Following the workshop, E2A assisted Niger’s MOPH to assess the country’s National Adolescent Health Strategy (2011-2015). The assessment was conducted using a new tool from West African Health Organization (WAHO)—“Orientation Guide for Developing National Strategies for Integrated Services for Adolescents and  Young People in the ECOWAS Region”—which E2A helped to develop. The MOPH is using the assessment results to develop a new national strategic plan with technical support from E2A, the World Health Organization, and WAHO.

Read the AYSRH best practices workshop report (English, French).

Togo: A 2014 study by the USAID/West Africa–funded, Engender Health-led project Agir pour la Planification Familiale (AgirPF) identified deficiencies in the availability and quality of SRH services for adolescents and youth in Togo. AgirPF and Togo’s Ministry of Health and Social Protection took the results of the study as a unique opportunity to act strategically to strengthen the health system in such a way that it is adapted to the needs of adolescents and youth. As a part of that initiative, AgirPF, in collaboration with E2A and Togo’s Ministry of Health and Social Protection, organized a national workshop on AYSRH, held September 8 and 9, 2015, in Lomé. The workshop was intended to be an opportunity to examine data related to AYSRH, evaluate concerns, and identify concrete actions to accelerate the operationalization of national policies and programs for adolescents and youth. A total of 71 people representing various government agencies, international institutions, youth associations and civil society organizations participated in the workshop. Results of the workshop were usesd to feed into development of a new national strategy for AYSRH in Togo.

Read the report from the workshop here (English, French).

Côte D’Ivoire: Similar to the workshop in Togo, on November 16-17, 2016, in Abidjan, E2A and AgirPF collaborated with Côte D’Ivoire’s Ministry of Health to organize a national workshop to examine challenges toward improved AYSRH in the country, to reflect on national priorities, and to identify concrete actions to accelerate the operationalization of policies and programs for youth. Around 80 people representing government ministries (ministries of health, education, family, professional training, youth); national NGOs and youth associations; national training and professional associations; and UN agencies, donor agencies, and international NGOs attended the workshop. Participants worked together to identify evidence-based practices to introduce or scale-up in order to address the country’s current AYSRH priorities, and opportunities to promote these evidence-based practices through the operationalization of national policies and programs. They made recommendations to strengthen collaboration and coordination to advance AYSRH.

Strengthening youth-friendly postabortion care services in Togo

Also, for the first time in Togo, E2A conducted a youth-friendly postabortion care-family planning (PAC-FP) training for public health providers. This effort built on a 2013 PAC-FP assessment conducted by E2A in four West African countries, including Togo, as well as quality improvement interventions E2A helped to implement at five health facilities that provide PAC. E2A helped the Division of Family Health to develop youth-friendly PAC training materials by adapting the adolescent-friendly PAC training guide from the PAC Consortium for use in Togo and adding sections on gender. The  adaptation included a strengthened module on screening for sexual and gender-based violence, focusing on building provider understanding of violence experienced by adolescents, improving provider counseling skills, addressing provider concerns and biases in screening for violence, and ensuring safety and privacy throughout the PAC counseling and service delivery process. Twenty-seven participants—22 providers and five Ministry of Health officials—attended the training on adolescent-friendly PAC-FP. AgirPF plans to scale up the youth-friendly PAC training to all of their sites in Togo and adapt the module for use in other countries.

Documentation of Pathfinder program for first-time mothers and young married women in Burkina Faso

Photo Credit: Abdoul Balde, Pathfinder International

Between 2012 and 2015, Pathfinder International worked with Burkina Faso’s Ministry of Health and local partners to develop and implement a project that has supported increased contraceptive use among young married women (YMW) and first-time parents (FTP) for healthy timing and spacing of pregnancies (HTSP). Because there is limited evidence about how best to reach this hard-to-reach population, the project implemented an intensive qualitative monitoring and documentation process with assistance from E2A to respond to this evidence gap. A technical brief  and report discuss findings from the project and offers lessons for supporting YMW and FTP to access information and contraceptive services that would allow them to practice HTSP in similar contexts. To continue to build the evidence base in this area, E2A has since gone on to test interventions for reaching first-time mothers with integrated SRH information and services in Nigeria and Tanzania.

Read the technical brief (English, French) and report (English, French).

Additional global and regional efforts that can be applied to West Africa

Youth-friendly services guide: decision-making tool for designing youth-friendly services

Collaborating with Pathfinder International, E2A developed a tool for the international SRH community—"Thinking outside the separate space: A decision-making tool for designing youth-friendly services." With the tool, E2A seeks to advance services tailored to young people’s diverse needs. The tool helps to guide program designers in selecting and adapting appropriate youth-friendly service delivery model(s), considering the country context, the target population, the desired behavioral and health outcomes, the SRH services offered, and the needs and objectives for scalability and sustainability. The tool contributes to a paradigm shift: from small-scale youth-friendly service initiatives previously based on a one-size-fits-all approach toward a health systems approach that meets the specific needs and realities of young people in different contexts. The tool has been used by governments and other stakeholders in Niger and Togo, and E2A is planning to assist the Government of Côte D’Ivoire with use of the tool. E2A is also collaborating closely with FP2020 to disseminate the tool internationally and across West Africa. The tool is available in English and French and will soon be available in Spanish.

Global Consensus Statement on expanding method choice for youth

E2A has been collaborating with a number of nongovernmental organizations, professional associations, and donors to raise awareness about the right of all young people to access a full range of contraceptives, including long-acting reversible contraceptives (LARCs). The collaboration resulted, in 2015, in the release of the Global Consensus Statement: Expanding Contraceptive Choice for Adolescents and Youth to Include Long-Acting Reversible Contraception. Over the past year or so, the statement has earned the endorsement of 51 NGOs, donors, governments, and professional associations including the International Federation of Gynecologists and Obstetricians, the International Confederation of Midwives, and the International Youth Alliance for Family Planning (IYAFP). E2A and the convener’s group around the Global Consensus Statement continue to roll out interventions and studies that expand young people’s access to LARCs.

Collaboration with Ouagadougou Partnership

E2A has been actively supporting the Ouagadougou Partnership since 2013. At the annual Ouagadougou Partnership meeting in 2014, E2A presented its experience with the ULC project in Niger. In 2015, E2A again participated in the Ouagadougou Partnership’s annual meeting, sharing good practices in AYSRH, and since then has been supporting the Partnership’s Coordination Unit to create a “Youth Partners’ Group” that will mobilize partners to operationalize the youth-related recommendations that were made during the 2015 meeting. E2A is currently supporting the preparation of the pre-conference meeting for the upcoming Ouagadougou Partnership meeting. The Ouagadougou Partnership Coordination Unit recognizes E2A as a strategic leader in AYSRH and the unit has expressed interest in collaborating with E2A to provide targeted technical assistance in Ouagadougou Partnership countries.

Collaboration with FP2020

E2A co-facilitated the FP2020 Regional Focal Point Meeting for Francophone Africa, which took place in Abidjan May 30-June 1, leading the youth session and providing support to focal point teams to develop work plans for accelerating progress towards achieving their FP2020 commitments. E2A is currently looking for an opportunity to provide technical assistance to support FP2020 focus countries to expand method choice for youth.  Also in partnership with FP2020 and IYAFP, E2A is planning to hold a web-based tutorial on the “Thinking outside the separate space" tool for a select group of IYAFP’s new country coordinators.

Collaboration with WAHO

E2A continues to work closely with WAHO. E2A co-organized the adolescent pre-conference meeting to the annual WAHO Good Practices Forum in October 2016 as part of the IBP Taskforce on AYSRH. E2A also participated in WAHO’s validation meeting for a new tool on national AYSRH strategies, which took place on June 28 – 29, 2016 in Dakar, and will continue to collaborate in dissemination and use of that tool as well as to strengthen AYSRH programs.


E2A will share some of these achievements, December 12-14, in Côte D’Ivoire during the upcoming 5th annual Ouagadougou Partnership meeting. Please keep an eye out for Katie Chau, E2A’s senior youth advisor who is based in Dakar, and Rita Badiani, E2A’s project director!