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RISE-FP INITIATIVE: Zinder, Niger BUILDING RESILIENCE

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RISE-FP INITIATIVE: Zinder, Niger BUILDING RESILIENCE THROUGH CAPACITY BUILDING AND INTEGRATION OF REPRODUCTIVE HEALTH AND FAMILY PLANNING FINAL REPORT Period: January 2017 to September 2020 FINAL REPORT 2017 _ 2020 RISE-FP Zinder-Niger 1 ABREVIATIONS - CBD: Community Based Distributor - ARV: Anti-retroviral - CCG: CoManagement Committee - CF: Conservation Farming - COIA: Analysis of the Context of Implementation and Adaptation - ANC: antenatal care - PNC: postnatal care - CRS: Catholic Relief Service - CSI: Centre de Sante Integré (Health centre) - DMPA-SC: Medroxyprogesterone acetate- subcutaneous - DRSP: Regional Directorate of Public Health / Direction Regionale de la Sante Publique - DS: Health District - E2A: Evidence to Action - CLC: Community Leadership for Change - ULC: University Leadership for Change - LARC: Long-acting reversible contraceptive - FP: Family Planning - PPFP: Post-Partum Family Planning - RISE: Resilience in the Sahel Enhanced - AYH: Adolescent and Youth Health - MCH: Maternal and Child Health - SONGES: Support to NGOs in the East and South - BEmONC: Basic Emergency Obstetric-Neonatal Care - RH: Reproductive Health - CT: Contraceptive Technology - PtC: Pathways to Change - HIV: Human Immunodeficiency Virus FINAL REPORT 2017 _ 2020 RISE-FP Zinder-Niger 2 Contents Background ................................................................................................................................................... 4 Project Approach and Partnership ................................................................................................................ 7 Key accomplishments ................................................................................................................................... 9 Objective 1: Increase demand for MCH/FP services among women, men, adolescents and young people of childbearing age in the Magaria, Mirriah and Matamèye districts of Zinder. .......................... 9 Objective 2: Increase access to FP services at the community level in the Mirriah and Magaria health districts and at the level of health structures and the community in the Matamèye health district. ... 21 Objective 3: Strengthen community resilience through integrated MCH/FP and resilience programs in selected communities ............................................................................................................................. 29 Objective 4: Contribute to existing efforts to strengthen the health system in the three health districts (Magaria, Mirriah, and Matamèye) of Zinder ......................................................................................... 33 Evolution of project performance indicators from 2017 to 2020 ............................................................... 35 Evolution of performance indicators during the extension phase ......................................................... 36 Evolution of project performance indicators, by health district............................................................. 37 Matameye District .............................................................................................................................. 37 Mirriah District (2 CSI): extension phase ............................................................................................ 40 Magaria District (3 CSI): extension phase ........................................................................................... 43 Major challenges and proposed solutions .................................................................................................. 45 Lessons Learned .......................................................................................................................................... 47 Recommendations for sustainability .......................................................................................................... 49 ANNEX: BENEFICIARIES’ TESTIMONIES ....................................................................................................... 50 FINAL REPORT 2017 _ 2020 RISE-FP Zinder-Niger 3 Background The Resilience in the Sahel Enhanced (RISE) Initiative is an extensive USAID-funded program aimed at building resilience in the Sahel, particularly in Niger and Burkina Faso. In Niger, the program was implemented by the NGOs National Cooperative Business Association (CLUSA), Catholic Relief Services (CRS), and the SAWKI project in the Zinder region, in the districts of Mirriah, Magaria, and Matamèye. During its implementation, the RISE program created a significant demand for family planning services that the existing health system was unable to meet. The USAID-funded RISE-FP Project was therefore developed to not only meet this demand, but also to strengthen community resilience by integrating family planning and reproductive health (FP/RH) services and the nutrition, conservation farming activities of the RISE initative. The project's lifespan was marked by four periods: - An initial implementation period: from January 2017 to September 2018, i.e. 21 months. - An initial extension period without cost: from October 2018 to June 2019, i.e. 9 months. - A second extension period with cost: from July 2019 to June 2020, i.e. 12 months. - A final extension period without cost: from July to September 2020, i.e. 3 months. After the first two periods (30 months total) in 5 integrated health centers (CSI), 20 health posts (CS), and 80 villages, and in light of the satisfactory results obtained, USAID granted a one-year extension with cost (July 2019 to June 2020) with an extension to an additional 3 CSI, 4 CS and 20 villages, then a three-month extension without cost from July to September 2020. Overall, the project's 100 community intervention villages covered a population of 133,759 in 2020. During this extension phase, in addition to family planning, the project also broadened its interventions to cover maternal and neonatal health care, including: antenatal care (ANC) and postnatal care (PNC), assisted delivery, and post-partum family planning. Villages were selected on the basis of the following criteria: - Village with no health facilities - Located within at least 5 kilometers of a health facility. - Population of at least 300 inhabitants. FINAL REPORT 2017 _ 2020 RISE-FP Zinder-Niger 4 Evidence to Action (E2A), through Pathfinder, worked with key partners in the USAID RISE initiative to increase access to a wide range of FP methods, focusing on injectables (including DMPA-SC) and long- acting reversible contraceptives, while targeting adolescents and youth. This project reflected the Evidence to Action (E2A) Project's framework for strengthening service delivery that addresses supply, demand, and an enabling environment for MCH/FP, with a focus on the challenges that constrain the delivery of essential services to women and youth. The project sought to increase demand for and access to reproductive health (RH) and family planning (FP) services in communities in the three districts of Zinder (Matamèye, Magaria and Mirriah) by integrating resilience efforts into FP/RH programs synergistically. More specifically, the project's objectives were to: 1. Increase demand for FP services among women, men, adolescents and youth of reproductive age in the Magaria, Mirriah and Matamèye districts of Zinder. 2. Improve access to FP services at community level in the Mirriah and Magaria health districts, and at the health facility and community level in the Matamèye health district. 3. Strengthen community resilience through integrated FP/RH and resilience programs in selected communities. 4. Contribute to existing efforts to strengthen the health system in the three health districts (Magaria, Mirriah and Matamèye) of Zinder. FINAL REPORT 2017 _ 2020 RISE-FP Zinder-Niger 5 RISE-FP Project , Village of N’goual gao, photo: Adama Ali Zourkaleini FINAL REPORT 2017 _ 2020 RISE-FP Zinder-Niger 6 Project Approach and Partnership The RISE project was designed to support the implementation of the Government of the Niger’s National Family Planning Action Plan (2013-2010) and to help it reach its ambitious goal of increasing contraceptive prevalence rate (CPR) from 12% in 2012 to 50% by 2020. The project specifically aimed to increase demand and access to family planning services in three health districts (Matamèye, Magaria and Mirriah) in the Zinder region and integrate with existing resilience programming in order to synergistically ensure that both family planning and resilience interventions achieve the desired outcomes at the community and facility level. The overall strategy of the project was an expression of E2A’s service delivery strengthening framework, which addresses supply, demand, and enabling environment, in particular those challenges that constrain delivery of essential services to women and youth. In addition, the project’s strategy was designed to complement the Government of Niger’s overarching strategic areas of improving the availability of family planning services at all levels of the care continuum (community as well as public and private health facilities), increasing demand for family planning services at all levels, and promoting a conducive environment for family planning. Furthermore, the project was integrated within and leveraged existing resources in the overall USAID/SRO’s Resilience in the Sahel Enhanced (RISE) initiative to improve the health and nutrition status of women and children under 5 years old, in order to reduce chronic vulnerability of populations to recurrent
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