Report of the Workshop for the Prioritization and the Dissemination of Best Practices in Adolescent and Youth
Sexual and Reproductive Health (AYSRH) in Niger
March 17-18, 2015, Niamey, Niger, Grand Hôtel
ACRONYMS AND ABBREVIATIONS
Agir-PF Advance Family Planning AIDS Acquired Immunodeficiency Syndrome ANBEF Niger Association for Family Well-Being AYHD Adolescents and Youth Health Department AYSRH Adolescent and Youth Sexual and Reproductive Health BCC Behavior Change Communication BP Best Practice CIPD International Conference on Population and Development CARMMA Campaign for Accelerating the Reduction of Maternal Mortality in Africa CORRECT Credible, Observable, Relevant, Relative advantage, Easy to install, Compatible, Testable CSO Civil Society Organization DHS-MI Demographic and Health Survey with Multiple Indicators E2A (Project) Evidence To Action FP Family Planning HDP Health Development Plan HV Home Visit IHC Integrated Health Center MCSD Mother and Child Survival Department MDG Millennium Development Goals MHERI Ministry of Higher Education, Research and Innovation MPH Ministry of Public Health MSI Marie Stopes International MVT Ministry of Vocational Training MYS Ministry of Youth and Sports NGO Non-Governmental Organization NHIS National Health Information System NRHP National Reproductive Health Program SG Secretary General STI Sexually Transmitted Infection TFP Technical and Financial Partner REACH Reflection and Action for Change UAM Abdou Moumouni University ULC University Leadership for Change UNFPA United Nations Population Fund USAID US Agency for International Development WASH Water, Sanitation, and Hygiene WHO World Health Organization YFC Youth-Friendly Center YFS Youth-Friendly Services
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Contents
1. INTRODUCTION……………………………………………………...………………………………4
2. WORKSHOP OBJECTIVES AND METHODOLOGY ...... 5 Objectives ...... 5 Methodology ...... 5 3. ADOLESCENT AND YOUTH SEXUAL AND REPRODUCTIVE HEALTH: CURRENT SITUATION, CHALLENGES AND OPPORTUNITIES ...... 5 3.1 Current Situation by the Ministry of Public Health ...... 5 3.2 International agencies’ interventions in AYSRH in Niger...... 7 3.3 “Visit to the Marketplace” ...... 8 3.4. Results of a survey on CSOs’ activities in AYSRH ...... 9 4. STRENGTHENING OF STRATEGIES TO IMPROVE AYSRH IN NIGER ...... 9 4.1 A decision-making tool for designing youth-friendly services ...... 9 4.2 Overview of elements for systematic analysis ...... 10 4.3 Screening of the movie “Binta’s Dilemma” ...... 12 4.4 ExpandNet/WHO Methodological Framework for Scaling-Up Successful Innovations ...... 12 4.5 Group work ...... 13 Main problems identified in the regions: ...... 13 Target-groups most affected by AYSRH issues ...... 14 The package of essential services offered to young people in regions ...... 14 Priority barriers to overcome in AYSRH ...... 14 Availability of infrastructure and human resources in the regions ...... 14 5. RECOMMENDATIONS ...... 14 6. NEXT STEPS ...... 15 ANNEX 1 – Agenda ...... 17 ANNEX 2 – Participant list ...... 18 ANNEX 3 – Posters from the Marketplace ...... 20 ANNEX 4 - Evaluation ...... 21
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1. INTRODUCTION
Niger, like many countries in West Africa, has a large and growing population of young people (aged 10 to 24 years), representing 32% of the country’s inhabitants. 1 The fertility rate in Niger is the highest in the world, with an average of 5.6 children per woman in urban areas and 8.1 children per woman in rural areas, resulting in a national average of 7.6 children per woman. 2 This high fertility rate is exacerbated by a shortage of resources for the health system, a conservative sociocultural environment and a large population underserved in health services and with very limited access to points of services. In addition, Niger also has the highest rate of early marriages and early pregnancies in the world with 75% of young women currently aged 20 to 24 married before the age of 18 and 30% before age 15. 3 At the same time, only 13% of women aged 20 to 24 uses a contraceptive method. This proportion is even lower among adolescents with only 6% of married girls and young women aged 15 to 19 using contraceptives. 4 Many young women in Niger have very closely spaced pregnancies, with approximately 23% of pregnancies being less than 24 months apart. 5 Closely spaced pregnancies are associated with a 51% increase of premature births, as well as a 61% higher neonatal mortality rate if the birth interval is less than 24 months. 6 Over the past few years, donor interest in Niger has increased and many organizations have been working to address those challenges and implement various interventions to improve Adolescent and Youth Sexual and Reproductive Health (AYSRH). Given the proliferation of these interventions, the number of competing priorities and the insufficiency of resources available to the Ministry of Public Health (MPH) in Niger, there is an urgent need for better coordination and concentration of actions to efficiently meet the specific needs of the youth. In this vein, USAID’s E2A project, led by Pathfinder International, has worked with the MPH to address these challenges. Several meetings have been organized to ensure better coordination of actions such as the Regional Meeting for best practices in AYSRH in West Africa held in Dakar, Senegal, in January 2014 in collaboration with Pathfinder and IPPF. The meeting was attended by representatives of the Ouagadougou Partnership member countries and sought to improve the governments’ commitment to introducing and/or scaling-up best practices that would increase the impact of their AYSRH programs. This conference gave countries a good opportunity to strengthen their understanding in AYSRH and to
1 Population Reference Bureau (PRB). The World’s Youth 2013 Data Sheet. PRB: Washington, DC, 2013. 2 Population Reference Bureau (PRB). 2013 World Population Data Sheet. PRB: Washington, DC, 2013. 3 The World’s Youth 2013 Data Sheet. 4 Ibid. 5 Niger DHS 2012. 6 Kozuki L, et al. BMC Public Health, 2013.
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discuss their needs and priorities. Another example is the national workshop on the Harmonization of AYSRH practices in Niger held in June 2014 by Pathfinder International and ANBEF (Niger Association for Family Well-Being) the IPPF affiliate in Niger. One result of this workshop was the creation of a general directory of organizations working in various AYSRH areas in Niger. Following these meetings, the MPH expressed an interest in holding a national workshop to explore more thoroughly the best AYSRH practices in Niger in connection with the existing national plans, roadmaps and activities. Therefore, the E2A project, in partnership with Niger’s MPH, organized the Workshop for the Prioritization and the Dissemination of Best Practices in Adolescents and Youth Sexual and Reproductive Health (AYSRH) in Niger, March 17 and 18, 2015 at the Grand Hotel in Niamey (see agenda in Annex 1). Approximately 70 people from various government agencies, international institutions and civil society organizations participated in the workshop’s activities (see list of participants in Annex 2). Drs. Asma Galy, DSP/CARMMA and Moussa Fatimata, Agir-PF Niger took turns facilitating during the two days. Representatives of the E2A project, ExpandNet and the MPH, served as facilitators during the workshops’ various sessions.
2. WORKSHOP OBJECTIVES AND METHODOLOGY
3.1. Objectives The workshop had four objectives: 1. Conduct deep and contextualized discussions on the evidence in AYSRH, including best practices; 2. Identify the challenges and the possibilities of strengthening support for programs and AYSRH services; 3. Assist with the operationalization of family planning strategies in Niger with the introduction and/or the scaling up of best practices in AYSRH; 4. Strengthen collaboration and coordination mechanisms in order to support AYSRH in the country.
3.2. Methodology Activities were conducted with a participatory approach around the followings points: Presentations Panels with experts Film screening Group work Visit to the market Further Group work Plenary discussions
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3. ADOLESCENT AND YOUTH SEXUAL AND REPRODUCTIVE HEALTH: CURRENT SITUATION, CHALLENGES AND OPPORTUNITIES
3.3. Current Situation by the Ministry of Public Health The population of Niger is characterized by its strong growth rate (3.9%) and its young population, which causes immense challenges in AYSRH, such as the following: Early age of first sexual intercourse with an average age of 15 for girls and 20 for boys; Early marriage and/or child marriage leading to early pregnancies and related complications; HIV/AIDS infection, particularly by girls and a low level of knowledge of how to protect against transmission. To face the challenges related to young people’s health, the government of Niger first established an AYSRH project prior to creating an YFS department designed to capitalize on the interventions of the MPH and its technical and financial partners (TFP). The AYHD’s accomplishments include: The youth strategy and national chart; The increase of youth-friendly centers (YFC) from 6 in 2006 to 50 in 2015, including 28 IHCs7 and their supply of drugs, and IEC and care materials; The development of several normative documents; The staff training in methods of approaching youth, syndromic management of sexually transmitted infections (STIs), FP, and on provider orientation about AYSRH; The training of young people in peer education and life skills; The production and dissemination of socio-educational materials; The production of a national survey on youth needs and aspirations; The sensitization of communities and young people; The integration of voluntary HIV testing in youth-friendly centers in 2012; The integration of AYSRH in public and private schools of health; The provision of condoms and contraceptives to youth. Some of the lessons learned by the MPH from the implementation of youth and adolescent health actions include: A deficiency in the policies/programs; A lack of visibility of the youth-friendly centers; Insufficient resource mobilization; A deficiency in interventions’ coordination/synergy (government, NGOs and cooperating agencies); Low participation of young people in AYSRH policies. The current environment offers many opportunities for implementing AYSRH actions in Niger. These include:
7 There are 2 types of youth-friendly centers, including the youth listening and advice centers: IEC activities to youth and advocacy to parents and community leaders ; the youth-friendly integrated Health centers (IHCs) : curative activities in addition to IEC and advocacy activities.
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The existence of the Ouagadougou Partnership that aims to revive FP in the 9 West African francophone countries; The availability of youth structures; The TFP’s support; The international commitments (MDG 5 and 6, CIPD recommendations, various charts ratified by the country); The development of policies favorable to Adolescents/Youth (NRHP/FP, AYSRH, HDP, etc.); The development and the implementation of health development plans HDP 2005-2010, then in 2011-2015 taking into account the YFS. In terms of prospects for the MPH Adolescent and Youth Health Department (AYHD), attention will be focused on making all existing youth-friendly centers functional, increasing the number of centers, mobilizing funds for the financing of YFS activities, creating a consultative framework in YFS, revising and validating the strategic plan, and sharing and capitalizing the good practices.
3.4. International agencies’ interventions in AYSRH in Niger The major AYSRH partners in Niger - WHO, UNFPA, UNICEF and USAID - explained how their respective agencies support YFS in Niger by: 1. Describing the agency’s mandate globally and locally. 2. Describing how the agency supports adolescent and youth sexual and reproductive health programs 3. Describing the successes and challenges encountered in their adolescent and youth sexual and reproductive health activities. 4. Describing their vision for adolescent and youth sexual and reproductive health in Niger. These international organizations support Niger through multi sectorial interventions for youth and adolescents. Thus, the WHO works with Niger’s MPH on developing health development plans (HDP) based on current norms and standards. Furthermore, the dissemination of best practices in Africa, the participation of youth in the improvement of their health, and the training of trainers of the youth- friendly centers are also fundamental axes of WHO interventions in Niger. In terms of addressing challenges, WHO is supporting two actions: ensuring that NHIS data on adolescents and youth is disaggregated by age group and by sex; and, self-mobilizing to ensure supply of drugs and the use of health services by youth. WHO will work on implementing three actions: an assessment of the orientation program taught to providers, an assessment of the AYSRH 2010-2015 strategic plan, and the strengthening of the coordination between TFPs and the Government in the review and development of policies related to AYSRH. UNFPA’s priority targets are adolescents and young people. Thus, the implementation of UNFPA’s public actions is built on the evidence in youth sexual and reproductive health. Currently, UNFPA operates according to a segmented strategy, focused on long-time marginalized groups of young people, like married youth and adolescents in and out of school. Similarly, UNFPA conducts advocacy actions
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towards state actors so that the NHIS data is disaggregated in order to take into account the diversity of the youth category. UNFPA’s biggest challenge in its AYSRH programs implementation is the operationalization of the youth- friendly centers, most of which lack a permanent activity organizer. UNFPA will work on developing inter sectorial actions to strengthen the collaboration between the MPH and other Ministries (Ministry of Youth, Ministry of Women’s Advancement, Ministry of Vocational Training, etc.) to improve the management of the multiple dimensions of the adolescents and youth needs. UNICEF‘s mandate is to work on the implementation of the children’s rights convention regardless of the situation (normal or emergency). Currently, UNICEF supports national policies through a five-year Niger-UNICEF cooperation program with two strategic axes: support to national policies and promotion of youth and adolescent resiliency. For UNICEF, the challenges are about the youth and their social environment (parents, society). Therefore substantial work needs to be done in areas like literacy and education while seeking to coordinate different partners’ interventions. USAID, a US Government agency, intervenes in Niger with an inclusive strategy and substantial financing for resiliency programs. These programs enable communities to face the challenges of food security, water, sanitation, and hygiene (WASH) and health. The principle of USAID’s intervention in health programs is to align these with the national health development strategy developed by the Government of Niger. The interventions are implemented by U.S. consortiums comprised by international NGOs such as Marie Stopes International, Fistula Care, REGIS/R (Burkina Faso, Mali, and Niger), Agir-PF, and projects like E2A. Major USAID funds are expected for the 2016-2018 period through existing projects. Moreover, USAID will support the work of development organizations around parents and the media on actions related to youth issues. USAID’s interventions expect the full participation of the MPH and the implementing organizations.
3.5. “Visit to the Marketplace” “The visit to the marketplace” was a workshop activity which gave non-governmental organizations working in Niger an opportunity to present their activities through a poster (see Annex 3 for more details). The participating organizations and respective activities were the following: Agir-PF Acting for Adolescent and Youth Sexual and Reproductive Health activities in Niger in the urban and peri-urban areas of Niamey and Maradi; Pathfinder International - “Mobilization Initiative for Access to Contraception for All” (IMPACT) in Dosso and Zinder ; Pathfinder International and ANBEF -- “Sexual and Reproductive Health of Married Youth and Adolescents Aged 10 to 24” in the Communes I and V of Niamey ; LAFIA MATASSA - Acting for Youth and Adolescent Health which is a partner of UNFPA’s adolescent initiative in Niger;
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E2A project (Evidence to Action) - University Leadership for Change at Abdou Moumouni University (AMU) of Niamey; Marie Stopes International (MSI) AYSRH Program in Niger; Animas Sutura Aventure de Foula (Condom Adventures) a communications campaign promoting adolescent and youth sexual and reproductive health to achieve “Zero unwanted pregnancy, Zero STI, Zero Forced marriage.” Population Services International (PSI) Univers Jeunes magazine Plan Niger Parce que Je Suis une Fille (Because I am a girl) campaign.
Participants were able to visit these NGO’s stands, to discuss and share experiences. The visit to the market enabled participants to list activities currently conducted in Niger to meet the needs of youth and adolescents. The exchanges of experiences were organized around two main axes. The first one was about activities implemented by the NGOs for young people: especially the establishment of safe spaces, capacity building for providers, mobile health service deliveries, behavior change communication, home visits, and the leadership of youth and collaboration between actors. The second axe dealt with issues related to youth such as: early marriage, non-respect of the law about the age of marriage for young girls, school attendance, insufficiency of collaboration between different stakeholders in terms of experience sharing and intervention sites, men and parents’ commitment to AYSRH, the sustainability of the activities after the NGOs departure, the involvement of the youth, etc.
3.6. Results of a survey on CSOs’ activities in AYSRH
In preparation for this workshop, E2A conducted a survey with fourteen civil society organizations to better assess the activities implemented for adolescents and young people in Niger. The survey addressed intervention approaches and targeted groups in their activities to benefit young people and adolescents. The survey revealed the following results: 1. Approaches used by the civil society organizations in their interventions for adolescents and young people. The survey showed that the approaches most used were peer education, youth-friendly services, YFCs, advocacy as a tool for behavior change communication (BCC), and the work with traditional leaders. 2. The age of the youth targeted by the CSOs. The answers indicated that most stakeholders work with young people between the ages of 10 and 24. The smallest percentage works with very young adolescents - those between the ages of 10 and 14.
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3. Specific target populations. The analysis demonstrated that most stakeholders work in urban and rural areas, with young people who attend school and those who don’t. Moreover, a small number of organizations reach young people living with HIV and young people who are first-time parents. 4. Intervention sites. The results showed that a large number of interventions were implemented in Niamey, while Diffa and Agadez areas had fewer projects. From this presentation, it became clear that many civil society organizations work to address the needs of adolescents and youth in Niger. However, the diversity of the needs in connection with the plurality of the adolescents and youth category is not always taken into account in the CSOs interventions.
4. STRENGTHENING OF STRATEGIES TO IMPROVE AYSRH IN NIGER
4.1 Thinking outside the separate space: a decision-making tool for designing youth- friendly services The E2A team presented its new tool titled “Thinking outside the separate space: a decision-making tool for designing youth-friendly services” developed as a decision-making device for program designers. This tool intends to guide the choice and adoption of service delivery models while taking into account the context, the target population, the desired results (for both behavior and health), the YFS services delivered, as well as the needs and objectives of scaling up and sustainability. The tool aims to diverge from the usual path by taking into account the diversity of situations and contexts. Indeed, there are many channels, modalities, structures and models by which youth-friendly services can be provided to young people. The most used approach is the creation of a separate space or service to ensure privacy and discretion, associated with entertainment programs that attract young people. Although adopted in various contexts of low or middle-income countries, this approach is not always the most appropriate in all local contexts, because it may not meet the specific needs, or because it is more expensive than other formulas or even because it is not appropriate enough for scaling up or sustainability. It is becoming increasingly clear, especially after the 2014 WHO report “Health of Adolescents in the World,” that the time has come to go beyond the small YFS initiatives to health systems adapted to the needs of adolescents. Moving in this direction requires a new perspective in the way donors, governments and NGOs conceptualize YFS. In fact, one will go from the “one-size fits all model” to a “specific model” finely adapted to the country’s context and to the needs of adolescents and young people. This tool helps actors adopt specific models through 7 well-defined steps. The workshop participants worked on the steps of the guide and identified recommendations to strengthen AYSRH strategies in Niger. 4.2 Overview of elements for systematic analysis One of the steps in the “Thinking Outside the Separate Space” tool is to make a systematic analysis of AYSRH. As a starting point, the concepts “adolescent” and “young people” must be defined. In Niger, these concepts are defined as followed:
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Adolescents are: people from the age group of 10 to 19 years Youth are: people from the age group of 10 to 24 years Young people are: people from the age group of 15 to 24 years Other important elements for a situation analysis are demographic and health indicators related to AYSRH, as well as elements to determine advocacy priorities. In Niger, the relevant indicators include: Sociodemographic indicators for adolescents and youth in Niger The proportion of adolescents in the Niger population is 22.1% where girls aged 10 to 19 years account for 21.8% of women. The proportion of youth aged10 to 24 years old is 30% where 20% of adolescents live in urban areas and 80% in rural areas. Full time education The percentage of youth aged 10 to 14 years attending primary school is 54.4% of boys and 45.1% of girls. Among youth 15 to 19 years old, the rates are 30.2% for boys and 17.9% for girls. In secondary school, the rate is 26.1% for boys and 18% for girls. The latter rates indicate that the attendance of girls in secondary school remain a challenge in Niger.
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Early marriage 61% of young people between the ages of 15 to 19 years old are already married or live with a partner. High social value placed on marriage can help explain this situation. Age of first sexual intercourse Most young women have had their first sexual intercourse before the age of18 and approximately 1 out of 5 have it before the age of 15. Pregnancies among adolescent females In a highly pronatalist context, where the number of desired children per woman is 8.1, 40.4% of adolescent females aged 15 to 19 have already given birth or are pregnant. 14% of birth intervals are less than 18 months, which increases the morbidity and mortality rates among both children and their mothers. The contraceptive prevalence rate among adolescent females The contraceptive prevalence rate among adolescent females aged 15 to 19 years is 5.9%; among married young women aged 20 to 24 years this is 12.6%; and among married women aged 15 to 49 years the rate is 13%. However, the contraceptive prevalence has increased from 5% in 2006 to 12% in 2012 (EDS-MICS), but the demand for contraception remains low, especially among adolescent females. The knowledge of modern methods Adolescent females and young women have good knowledge of modern methods of contraception. This level of knowledge has increased since 2006. Indeed, 74% of young girls know the modern contraceptive methods, but only 5% have already used a contraceptive method to delay or avoid a pregnancy. Reasons for the non-use of modern methods – adult women The reasons for the non-use of modern methods of FP among adult women include: the limited decision- making power of women, social norms, underlying factors and the lack of access and provision to modern methods, as well as some perceptions of Islam. Reasons for the non-use of health services – adolescent females At the adolescent females’ level, the reasons for the non-use of AYSRH services are: lack of financial resources for treatment (52%), geographic accessibility (39%), transportation issues (38%), fear of going alone to the clinic (32%), and having permission for treatment (22%). Maternal mortality among adolescent females and young women While contributing to 14% of the general fertility, adolescent females aged 15 to 19 years contribute to 25% of maternal deaths. Women younger than 24 years old contribute to 52% of maternal deaths.
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HIV Regarding HIV, indicators show that 12.3% of adolescent females and 21.3% of adolescent males have thorough and accurate knowledge of HIV; 13.3% of adolescent females and 39.4% of adolescent males know where to buy condoms. HIV prevalence among adults aged 15 to 49 years remains low at 0.4%, but youth are still at risk, as their knowledge level is low. Debates after the presentation Two debates were generated after the presentation. The first was regarding the non-availability of statistics about induced abortion of pregnancies and how this remains a barrier for AYSHR in this area. The second one was TFP’s poor commitment to use mHealth/mSanté’s mobile phone services to follow up on pregnancies, which resulted in financial issues for the service provider.
4.3 Screening of the movie “Binta’s Dilemma” The E2A project leads the University Leadership for Change (ULC) program, implemented at the Université de Niamey using the reflection and action for change (REACH) methodology.
In this context, E2A produced a movie based on information collected on barriers and facilitators to access sexual and reproductive health services. This information was collected by peer educators using a collection tool developed by Pathfinder International called “Pathways to Change.” The movie, “Binta’s Dilemma”, is a work tool used by peer educators during meetings to trigger debates, reflections and actions on issues that students, and youth in general, face daily.
The screening sparked many reactions on various aspects, including: The fact that the movie does not have a normative style. The objective of the movie is to enable a debate from a real-life situation and does not suggest what should be done. Reflections on service quality. The lack of confidentiality in health centers and reception of clients; the importance of providing a full range of FP products to students. Reflections on the influence of mothers-in-law and friends in the decision-making for the use of FP. Reflections about young women’s choice between pursuing school and getting married. Following those debates, some participants suggested the creation of additional episodes that address the change that took place. The production of these episodes may provide further opportunities for TFPs to collaborate.
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4.4 ExpandNet/ WHO Methodological Framework for Scaling-Up Successful Innovations Scaling up is the last step of the E2A project guide “Thinking Outside the Separate Space”. For this purpose, ExpandNet presented their scaling-up framework that was developed in 2003 by WHO and the University of Michigan which emphasizes that scaling-up can be either vertical (or institutional) or horizontal (extending to new sites or reaching new groups). It is a deliberate effort for organizations to ensure a successful pilot and have sustainability in the interventions. Scaling-up is based on a systemic approach, sustainability, service determinants, human rights and equity. This methodological framework outlines the importance of taking into account the context in the strategic choices for scaling-up. It should be noted that scaling up is easier if it is considered at the beginning of the pilot project. The good management of a pilot project must take into account seven requirements for scaling up success, also called CORRECT characteristics. These are: credible, observable relevant, relative advantage, easy to install and understand, compatible and, testable. Regarding organizational context, the implementing organization, for example the MPH, should be committed to scaling up. Additionally, the team involved in the scaling up process must be well trained and committed. According to some participants, the conditions to make scaling-up CORRECT, “are not carved in stone” and scaling up is “a tortuous river, not a channel.” For other participants, the multiple pilot-projects without a scaling up component should draw inspiration from projects that do use a scaling up system, particularly those using an efficient monitoring and evaluation structure. 4.5 Group work Participants were divided into 6 work groups based on regions (Dosso, Maradi, Niamey, Tillabery, Tahoua/Agadez and Zinder/Diffa) and were invited to reflect on the seven steps of the guide using the following points as reference: Main problems young people face Specific target-groups Essential services being offered Barriers to overcome Available infrastructure and human resources Models and the scaling of youth-friendly services. The summary of the results highlighted the following situations in Niger regions: Main problems identified in the regions: The main AYSRH problems young people face in their respective regions are the following: Insufficiency of SRH information, Stigmatization, lack of sexual education in families, Unavailability/inaccessibility of SRH services, High HIV/AIDS prevalence,
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Early and/or forced marriage, Obstetric fistula, Unwanted pregnancies, cultural barriers, The need to listen, Insufficiency/poor geographic distribution of youth centers, Illegal abortion, Clinic hours inappropriate to the needs of young people, Illiteracy/dropping out of young people, Street children, child labor, Drug addiction. In addition, some problems are specific to other areas like towns bordering Nigeria which are facing displacement of children because of Boko Haram attacks.
Target-groups most affected by AYSRH issues According to the results of work in this area, the target groups most affected by AYSRH issues are numerous and varied. Generally, these groups include young women and young men, married and unmarried, aged 10-14, 15-19 and 20-24, living in rural and urban areas. The work groups also identified some subpopulations that are particularly marginalized and affected by AYSRH issues. They are specifically sex workers, women with fistula, female victims of sexual violence, married children and children with disabilities. Essential services offered to young people in regions The essential services being offered in regions include the following components: prevention which includes activities such as: counseling, support groups, home visits, and community-based IEC; curative axis on case management (STI, HIV, etc.), mobile clinics, health consultations, drug treatment centers; and the support to young people through resiliency programs and social reintegration. Priority barriers to overcome in AYSRH Respondents identified three types of priority barriers. Environmental barriers such as geographic and financial accessibility to health services, and services which are poorly adapted to the needs of youth and lacking confidentiality; social barriers including the influence of parents, and judgment by health providers; and personal barriers such as shame and fear of the judgment by others. Availability of Infrastructure and human resources in the regions Regarding infrastructure, there are a multitude of public and private health structures intending to meet the needs of young people in the regions such as IHCs, listening centers, youth-friendly centers, NGOs, mobile services, community-based radio stations, community-based distribution kiosks, husband schools. However, these infrastructures are insufficient and ill equipped to take care of young people’s issues in Niger. The available human resources include nurses, midwives, doctors, community relays, peer educators and agents of the ministry of youth. Nevertheless, these are also not enough in numbers and, for the most part, providers lack training on how to approach youth.
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5. RECOMMENDATIONS
A number of recommendations were made during the workshop. 1. Human Resources Training Strengthening health provider skills in youth approaches and youth-friendly case management (PMTCT, FP, AYSRH); Training community volunteers and CHWs in youth-friendly services and AYSRH approaches; Building capacity through trainings and supervisions.
2. Programs and Strategies Establishing a system of care management/free care for adolescents and young people (e.g. social tickets for adolescent females); Creating income-generating activities for adolescent females; Strengthening and extending husband schools; Advocating for the strict application of the law prohibiting early marriages; Establishing actions to fight against narcotic drug consumption; Training peer educators at the school level; Rehabilitating the different youth-friendly centers while taking confidentiality into account o Equipping them with needed materials and supplying them with case management products. o Offering prevention activities adapted to young people in the IHCs
3. Behavior Change Communication Multiplying educational supports on AYSRH specifically targeting married and unmarried adolescent females; Strengthening sensitization activities among married adolescent females, their husbands, and influential people and leaders; Strengthening target-groups sensitization about the existence of AYSRH and the minimum package of activities offered.
4. Youth Governance Mapping organizations and interventions existing at the field level in order to improve coordination and synergy; Creating consultation and synchronization frameworks between different partners and public services; Involving youth more in the design and implementation of actions concerning them;
5. Supervision Strengthening the decentralized supervision system Giving regions the means to follow-up AYSRH activities, including youth-friendly centers and listening centers.
6. Monitoring and evaluation Strengthening monitoring and evaluation systems for AYSRH data collection; Establishing an efficient M&E system at the national level.
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7. Advocacy towards the TFPs Conducting advocacy actions towards partners for financing of AYSRH.
6. NEXT STEPS
Following the workshop, the MPH’s Adolescents and Youth Health Department (AYHD) was committed to coordinate these steps: Disseminating the workshop report; Organizing a meeting with all AYSRH partners to create a consultation framework around AYSRH in Niger (It should be noted that this point has been subject to a rich debate between participants on the periodicity of the framework meetings as well as on its leadership). Contributing to the creation of a AYSRH database by supplying the MPH with data Creating a national committee for the monitoring and evaluation of AYSRH activities.
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7. ANNEX 1 - AGENDA
Workshop for the prioritization and the dissemination of Best Practices in Adolescent and Youth Sexual and Reproductive Health (AYSRH) in Niger March 17-18 2015, Niamey, Niger, Grand Hôtel
HOURS THEMES Responsible
D1
8:00 – 8:30am Reception/ Seating of participants / FATHIA Organizers
8:30 – 8:45am Partners’ speeches Ouagadougou Partnership, USAID Niger
8:45 – 9:00am Official opening GS/MPH
9:00 – 9:10am Administrative formalities Accountant Pathfinder
9:10 – 9:45am Presentations by Participants Moderator (GM PH)
9:45– 10:00am Presentation of the Schedule Moderator (GM PH) Presentation of the workshop’s objectives and Dr. Ali Halima - AYHD methodology
10:00 - 10:30am AYSRH Situation in Niger Dr. Ali Halima - AYHD
10:30 – 11:00am Coffee Break
11:00 – 11:30am Panel: How international agencies help Niger meet Resident Representatives of: AYSRH needs UNFPA, UNICEF, WHO, USAID
11:30 – 12:45pm « Visit to the Market »: How partners meet AYSRH Katie Chau - E2A/Pathfinder needs in Niger International
12:45 – 1:45pm Lunch Break and prayer
1:45 – 2:00pm Feedback on the « visit to the market » Katie Chau - E2A/Pathfinder International
2:00 – 2:30pm Presentation of the youth guide: a tool for decision- Regina Benevides - making E2A/Pathfinder International
2:30 – 3:30pm Overview of the elements for AYSRH systematic Katie Chau and Heather analysis Forrester- E2A/Pathfinder
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International
3:30 – 4:00pm Group works (step 3 of the guide)
4:00 – 4:15pm Coffee break / prayer
4:15 – 5:00pm Continuation of group works (step 3 of the guide) Facilitators
5:00pm End of D1 Moderator (SP)
D2
8:30 – 8:45am Summary of D1 Moderator (GM PH)
8:45 – 9:15am Screening of the “REACH” movie– Binta’s Dilemma Ousseini Abdoulaye - E2A/Pathfinder International Niger Students at l’Université Abdou Moumouni - E2A Niger
9:15 – 10:15am Group works (step 4 of the guide) Facilitators
10:15 – 10:45am Approaches for the scaling-up of health interventions Modibo Dicko - ExpandNet
10:45 – 11:00am Coffee Break
11:00 – 12:00pm Group works (steps 5 and 6 of the guide) Facilitators
12:00 – 1:00pm Presentation of the results of the group works (D1 and Group reporters D2) (G1,2,3)
1:00 – 2:00pm Lunch break and prayer
2:00 – 3:00pm Presentation of the results of the group works (D1 et Group reporters D2) (G4, 5,6)
3:00 – 4:00pm Recommendations and next steps Dr. Ali Halima - AYHD
4:00 – 4:15pm Coffee break/prayer
4:15 – 4:45pm Evaluation and certificates awarding Regina Benevides - E2A/Pathfinder International
4:45 – 5:00pm Closing MCSD / MPH Reporters D1: Tahoua, Maradi, Agadez, Dosso, student (Gouzae Tounkara Aichatou) Reporters D2: Tillabéry, Diffa, Zinder, Niamey, student (Tambari Sani Tanimoune) Final Report: Mme Idrissa Fatouma (AYHD), Ousseini Abdoulaye (E2A), Adamou Gaoh Farouck
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8. ANNEX 2 – PARTICIPANT LIST
Name Organization Allagouma Noufou Maiga ANBEF Fourératou Yahaya Tourawa Animas Sutura Franzke Monika Animas Sutura Idrissa Garba Animas Sutura Mahazou Mahaman Animas Sutura Seyni Yacouba Animas Sutura Baza Mariama CNOU Sadia Mamane Asda CTH Dr. Asma Galy DGSP Department of the Promotion of Women Mme. Sani Aissa Sadjo and Gender of the Ministry of Population Dr. Halima Moumouni AYSRH Department Dr. Kalla Idi DRSP Maradi Mme. Moussa Fatima DRSP/Ny Abamy Hammatou MCSD Abdoulaye Zeinabou MCSD Abdourahim Soumana MCSD Dr. Adama Kemou MCSD Dr. Yerima Saadatou MCSD M. Salif Arzaka MCSD Mme. Ali Habiba MCSD Mme. Fanna Ari MCSD Mme. Harouna Kadidia MCSD Mme. Idrissa Fatoumata MCSD Moussa Mamoudou MCSD Nafisa Djamila MCSD Zada Aichatou MCSD Dr. Hinsa Solange MCSD/PMTCT Heather Forrester E2A Katie Chau E2A Ousseini Abdoulaye E2A Regina Benevides E2A Aboubacar Mai-Birni EngenderHealth Dr. Fatimata Moussa EngenderHealth/ Agir-FP Issoufou Nouri Dini EquiPop Modibo Dicko ExpandNet
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Dr. Alli Assomane Hassana Institute Niamey M. Moctar Diallo IntraHealth/CS4FP Rodgrigue Ngouana IntraHealth/Ouaga Partnership Moumouni Bonkougou Jhpiego Gado Sabo Issa Lafia Matassa Yaou Moussa Lafia Matassa Mariam Dodo LAHIA/SCI Saratou Abou LAHIA/WVI Hedwige Hounon Marie Stopes Abdoulaye Philomane Ministry of Youth and Sports Ali Hadiza Ministry of Promotion of Women Boukau Aleena MPH Rep Agadez Brah Abdourahamane MPH Rep Diffa Mme. Garba Maimouni MPH Rep Dosso Mme. Mariane Aissatou MPH Rep Tahoua Saibou Hamidou MPH Rep Tillabery Mme. Sabo Aminata MPH Rep Zinder Sebastien Barraud MSI Mme. Sirfi Haoua MPH - Division AYSRH Mahamadou Sahda NGO ATND Ary Issaka Ousmane NGO Tchouda Gna Dr. Sani Aliou Pathfinder Kiki Kalkstein Pathfinder Saidou Idi Plan Mouslim Sidi Mohamed PSI Rachid M. Kagone PSI M. Farouck Adamou Gaoh Reporter Adamou Abdoul Kader Regis-Er Circey Trevant Save the Children Dr. Idrissa Maiga Secretary General Abdoulaye Hasana AYSRH Idi Cheffou TRANSLATOR Abdoulaye Gado Sabo Fadimata UAM Aichatou Gouzaé Tounkara ULC student AMU Assamaou Maman Bizo ULC student AMU Fatimata Abdoulaye ULC student AMU Hassane Habari (Max) ULC student AMU Innocent Ibrahim ULC student AMU Tambari Sani Tanimoune ULC student AMU Haoua Boubacar UNFPA Dr. Hamadassalia Touré UNICEF
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Mme Safia Abdoul Wahi USAID Niger Amy Uccello USAID Washington Cate Lane USAID Washington Dr. Balkissa Adamou Moumouni WHO Niger
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9. ANNEX 3 - POSTERS FROM THE MARKETPLACE
Available upon request http://www.e2aproject.org/contact-us.html
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Translation:
University Leadership for Change – Abdou Moumouni University (AMU) in Niger Context Niger population is young 32% of the population is young (10-24) High fertility rate: 8.1 children per woman (15-19) 13% of women aged 20-24 years use a contraceptive method 6% of girls aged 15-19 use contraception 28% of girls are married before the age of 15
Source Niger DHS 2012
Our approach
University peers E2A + Local Partnership AMU MPH Providers – University Health Services – Health Center (3) IEC and BC in SRH (2) Capacity in AYSRH
Students Community Youth * We suggest the use of Pathways to Change, the REACH approach, other reinforcement activities and a “norm change” technique, which could all use Internet with cell-phones
Results (April 2014 – March 2015)
Activities Number
Peer educators trained 79 Supervisors trained 19 HIV Testing 161 VTC Organized 38 Conferences/debates 02
Midwife’s appointment to CSM/CNOU Supply of contraceptives, including condoms, to the center
Challenges
Putting in place a quality AYSRH service at the University Overcoming barriers that prevent students from becoming agents of behavior change
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Translation:
LAFIA MATASSA NGO Acting for Adolescent and Youth Health Phone: 20 35 15 04 PO BOX: 11906 Office: Neighborhood Dar Es Salam E-mail: [email protected] Initiative Adolescentes’ implementing partner in Niger Success during pilot phase Girls oppose early and forced marriage: 93.3% of them think it is for them to choose their husbands and most of them hope to get married at the age of 19, have their first child at 21 and have a total of six kids. Girls have better knowledge in health: at the beginning of the program, only 11.6% of adolescent females knew how to avoid a pregnancy; at the end, 88.7% of girls knew at least three methods. Girls changed their behavior related to health: the use rate of a contraceptive method, even if it remains weak, doubled: among unmarried girls, it increased from 3.4% to 7.3% and among married girls, it increased from 18.8% to 34.1%. Dialogue is established in the community: for communities, it was the first time issues regarding privacy were discussed publicly. Dialogues confirmed the need of debates on these issues. Challenges Girls target self-sufficiency: The reflection about the program continues, because the girls ask a lot for vocational training and income-generating activities in order to be more self-sufficient in their future life as women and as mothers. Men’s commitment to RH Target Girls aged 10 to 19 years: Who never went to school or dropped out of school Unmarried or married Because girls face a lot of problems: A neglected category Health Education Social isolation Poverty Violence and other risks Context 75% of 18 year-old girls are already married and 1 out of 3 girls under 15 years-old is already married. Every DAY in Niger: 256 births among girls aged 15 to 19 years 28 births among girls aged 12 to 14 years Objective Initiative Adolescente intends to fight against forced marriage and delay adolescent marriages and pregnancies.
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For MSI Niger’s sensitization activities, a strategy to reach young people in some outskirts of Niamey (Talladjé, Madina, Boukoki and Aéroport) was used: Meeting with young people in the fadas The leaders of these neighborhoods were approached and sensitized to AYSRH Then, they mobilized young people to make them participate in sensitization sessions 2 Marie Stopes Ladies offered FP services in 2 youth centers (Boukoki and CNASEC), once a week. 1 mobile team (USAID/SIFPO) offers services in health huts during public consultations as well as a week-long outing once a month, with focus on married adolescent females From July to December 2014, the Health and Sensitization Workers sensitized 26,217 people. 2030 of them were young people
People reached from July to December 2014 Young people reached 8% Men 38% Women of Reproductive Age 54%
Figure: percentage of people reached by MSI Niger’s health and sensitization workers from July to December 2014
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Objectives, Target Groups and Profiles
Age group 15 to 25 years-old
Niamey and Tillabéry Regions
Married and single young people, in school or not, 2992 who had an FP session Offer of services to women and young girls with disabilities in the neighborhoods of Niamey Vulnerable Young people during food distribution by USAID from December 2014 to January 2015
The project will mainly help women and young girls who are the most vulnerable to maternal mortality, including young people and women who have multiple partners, with a focus on the most vulnerable women, meaning the poor living in rural or periurban areas who have limited access to quality sexual and reproductive health services.
Desired Health Goal
Reduction of maternal mortality by improving access to and use of reproductive health services and family planning services in underserved communities.
MSI Niger aligns itself with the objectives of the FP plan (2013-2020), which is to increase the contraceptive prevalence rate from 12% in 2012 to 25% in 2015 and to 50% in 2020. However, there are major variations in this contraceptive prevalence, with for example, only 6% of the 15-19 year-old people who use a modern contraceptive method. The Action Plan also addresses the insufficient delivery of advice and services, especially long-acting methods. Only 0.5% of married women currently use a long acting method, which is indicative of the lack of choice of contraceptive methods. For all these reasons, MSI Niger wants to contribute to the improvement of the access for young people to quality service delivery.
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Translation:
IMPACT Niger (Logo) Mobilization Initiative for Access to Contraception for All a project of Pathfinder International Project Mobilization Initiative for Access to Contraception for All (IMPACT) PRESENTATION The project Mobilization Initiative for Access to Contraception for Al l– IMPACT - in Niger is funded by the Bill and Melinda Gates Foundation and implemented by Pathfinder International in two regions of the country. The goal of the project is to support the Nigerien Government in its efforts to accelerate access to family planning, with a focus on access to injectables and long-acting reversible contraception (LARC). TECHNICAL AREA The IMPACT project in Niger works in the Family Planning field. ZONE OF INTERVENTION The IMPACT project in Niger works in two regions: in Dosso in the health districts of Dosso; Doutchi and Loga, and in the Zinder region in the health districts of Mirriah, Magaria and Goure. DURATION OF THE PROJECT The IMPACT project is scheduled for four years, from 2014 to 2018. MAIN TARGET POPULATION: The IMPACT project has three targets: married women and young unmarrieds, post-partum clients and other women at child-bearing age with unmet need in contraception. OBJECTIVES The IMPACT project has three main objectives: 1. Increasing access to and use of quality FP services at the community level, including the injectable contraception, through civil society and partners from government; 2. Increasing access to and use of LARC through well-coordinated actions, friendly mobile outpatient services; 3. Reinforcing the capacities of the MPH’s FP department in performance management and monitoring progress towards the goals and insuring technical leadership in the deployment of the national FP plan. INTERVENTION STRATEGIES The intervention strategies of the IMPACT project in Niger are, among others: Capacity-building of the IHC agents and the district management team on contraceptive technologies… including CHWs and CRs; Increase in frequency and coverage of IHC’s integrated public outings; Mobile clinic integrating SMI-FP (including implants) by the district team is operational in Goure; Active “Tutoring” offer conducted at the IHC level in order to reinforce the availability of long- acting reversible methods and close to the community;
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A coordination mechanism with different implementing partners is established in order to enable refferals for IUDs and for implants (CR, backup services, mobile services).
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10. ANNEX 4 – EVALUATION OF THE WORKSHOP
At the end of the workshop, participants completed individual anonymous evaluation forms. The methodology used was the following: the questions were of two types (open-ended questions and closed-ended questions). The results are shown in the table below:
QUESTIONS ANSWERS
Very clear – 27 answers 1. The defined objectives were Clear – 18 answers Not clear – 1 answer
Fully - 27 2. In my opinion, the workshop’s objectives More than half - 16 have been achieved Half - 3
Less than half - 0
3. Among the topics discussed, which ones were you most interested in:
Movie ExpandNet AYSRH Youth Guide Visit to the Group Work Situation Market
10 20 6 7 12 8
Very useful - 40 4. In relation with your future AYSRH activities in Somewhat useful - 6 Niger, this workshop was: Not very useful - 0
Not useful - 0
ExpandNet – 10 5. What major changes are you going to make after Youth centers’ Revitalization – 3 learning from the knowledge and skills discussed during this workshop? Encouraging young people to attend the YFS-4
Too long - 2 6. The duration of the workshop (2 days) was: Long enough - 19
Too short – 24
Agree - 43 7. Facilitators’ efforts to achieve the objectives were Undecided – 2 effective Disagree -0
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Enthusiastic - 18 8. The moderator and the facilitators seemed to me: Competent - 34
Accessible - 12
9. What is your appreciation of the methods used:
Technical Presentations Panels (e.g. Situation, “ Visit to the Working REACH (Opening, overview of the market” Groups TFPs’ panel) evidence, Movie scaling-up, etc.) Excellent 11 24 20 19 30 Good 30 17 22 23 14 Fair 3 1 1 2 1
Agree - 42 10. The organization of the workshop was Undecided - 1 satisfactory Disagree - 1
In the organization: The meals/the catering - 8 The time management – 6 The location - 3 11. What have you particularly appreciated The availability of materials - 3 during this workshop? During the sessions:
The work in group - 12 ExpandNet - 5 The topics/thematic relevance-4 Visit to the market - 7
Participants not on time - 8 12. What haven’t you liked during this Group work - 2 workshop? Insufficiency of time - 5
Increase the duration of the workshop– 9 13. What are your recommendations to Respect the time - 6 improve the organization of such workshops in the future? Replicate the workshop at the regional level – 3 More youth participation - 4
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