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World Neighbors in ACTION World Neighbors IN ACTION Developing a Framework for Integrating Reproductive Health in Development Programs This issue describes a process for synthesizing lessons learned from program implementation in six countries and using those lessons learned to adapt a programmatic framework. The framework is intended to guide the development and implementation of reproductive health components in integrated programs in order to maximize their effectiveness. Background The key elements of the framework Since 2000, World Neighbors has developed in 2000 were: been using a framework for reproduc- tive health components developed by 1) Integration Linkages: WN pro- 5) Action Learning: Action learn- international program staff during a grams are integrated development pro- ing is the systematic and participa- workshop. The framework was used grams. RH components are linked tory analysis, learning and documen- to guide the development of reproduc- with other activities identified as pri- tation of program need, context, pro- tive health components in the context orities by local communities. cess, outcomes and impact. Action learning is used to inform decision- of World Neighbors’ integrated pro- 2) Information and Counseling: making, improve programs and gramming. The accessibility of accurate RH in- widen impact. Integrated development programs, formation is seen as critical for the suc- such as those WN implements with cess of a RH component. 6) Gender: The WN program partners, are very complex and require strategy specifies that programs will 3) Quality Reproductive Health managers to balance a large number respond to community needs Services: Improving access where of activities and priorities. Thus, the through an empowering, gender- necessary and strengthening the link- framework has proved to be a useful sensitive and holistic development ages between community-based struc- tool in ensuring that key elements of an process. Gender issues are an im- tures and formal RH services is seen effective RH component are not over- portant consideration in the devel- as vital to the effectiveness of RH looked during the design, implementa- opment and implementation of ac- components. tion or evaluation of programs. tivities. 4) Community Local Capacity When the original framework was de- 7) Special Groups: This element Building: In all aspects of its work, veloped WN staff acknowledged that emphasizes addressing the needs of WN seeks to strengthen the capaci- the framework was dynamic and vulnerable groups such as adoles- ties of communities and local organi- should be refined and adapted as the cents, migrants and their families. RH components evolved. The frame- zations to determine their own devel- work had seven components. See box opment priorities and act on them. on right. The first part of the workshop included that there were significant differences Revising the Framework Based on presentations that incorporated recent in design of the programs and each pro- Program Learning evaluation results for six country pro- gram offered learning on reproductive At a recent meeting in February 2003, grams; India, Nepal, Bukina Faso, health in a unique context. World Neighbors’ staff and partners Kenya, Haiti and Ecuador. Each pre- Each of the six program presentations took the opportunity to review lessons sentation used the 2000 framework to used a common framework which fa- learned during the past three years and summarize their program approach, but cilitated analysis and synthesis across make changes as indicated to the also presented key lessons learned over the programs. framework. the past three years. It should be noted WNIA SPRING/SUMMER 2003 SUBJECT: INTEGRATING REPRODUCTIVE HEALTH IN DEVELOPMENT PROGRAMS VOLUME 29, NO. 1E PROGRAM PRESENTATIONS Objective: • Information on Program Context and 2) Participants were asked to note To share program information in a History during each presentation key questions way that promoted synthesis and • RH Component Design: How are and lessons learned that they found sharing of lessons learned. each of the seven key elements relevant to their programs. Methods: implemented in the program? 1) Each country had 30 minutes to • Program Objectives present their program followed • Unique Aspects or Initiatives of the by questions for clarification as RH Component necessary. They presented ac- • Key Accomplishments and Evalua- cording to the following format: tion Results • Lessons Learned and Sharing Burkina Faso described a key lesson as the importance of influ- encing of key leaders, such as religious leaders, elders, and tra- ditional singers, because of the important roles they play in local decision-making. Special training improved their knowledge of RH and their attitudes toward the program so that they became supportive. The Nepal and India programs discussed the importance of women’s savings and credit activities in their programs. They noted that the activities influenced health service use in two ways. First, because women had access to money, they could afford to use services when they needed them. Second, women with their own income have more influence in a household and more au- tonomy. The Kenyan program talked about their capacity building efforts with the local health facility management committees. They high- lighted the necessity for communities to understand and have expectations regarding the quality of care provided at health fa- cilities. They noted that in their experience “community partici- pation will create a sense of ownership of health activities, ser- vices and facilities.” WNIA SPRING/SUMMER 2003 SUBJECT: INTEGRATING REPRODUCTIVE HEALTH IN DEVELOPMENT PROGRAMS VOLUME 29, NO. 1E ROUNDTABLES The presentations were followed by Method: roundtable sessions in which the par- 1) Presenters from each of the 3) After 30 minutes, each group ticipants had the opportunity to ask country presentations were rotated to a different table. In questions and deepen their under- stationed at different tables. this way, each group had a standing of the programs. 2) Participants were divided into chance to visit each table where small groups of 5-8. Each small presenters were stationed. Objective: group went to a different table To explore issues in more depth in and further discussed questions small group sessions. and issues raised from the pre- sentations. A record keeper was assigned to each table. How are the RH outreach services (gynecamps) organized? WN works with the local NGOs to organize volunteer physicians to go to communities to provide health services. They travel with all the necessary equipment and supplies. In this way, they can carry out minor surgery as necessary, including tubal ligations. They can also perform important diagnostic procedures such as EKG and ultrasound. In Ecuador, why do you think that sustainable agriculture promotes health? There are three basic reasons. First, there are cultural reasons, because there is a logical link between the concepts of soil fertility and human fertility. Second, there is the involvement of men. The inclusion of agriculture permitted male participation. The men began to have better impressions of CEMOPLAF (World Neigh- bors’ partner in Ecuador), and began to permit women to work with the organization. Third, there is economics. Agriculture leads to income generation and food production—that motivated people to get involved. How does migration affect reproductive health in Haiti? In areas where the harvest is poor, women are usually the ones who travel to do petty commerce. This means that women spend long periods away from their husbands and families. These women are very vulnerable, because they are often forced to sleep in the open markets to protect their goods. When women have the possibility to do income-generating activities at home, they will stay with their families. This is one reason that the program has dedicated some funds for women’s income-generating activities. WNIA SPRING/SUMMER 2003 SUBJECT: INTEGRATING REPRODUCTIVE HEALTH IN DEVELOPMENT PROGRAMS VOLUME 29, NO. 1E FIELD VISITS Objectives: 3) To gain a better understanding of 2) Participants visited local NGO 1) To gain a better understanding the integrated approach of World partners, community-based of the community management Neighbors in Kenya. organizations, health facilities of facilities and quality of care and communities. Method: monitoring. The next day, the participants 1) Participants were divided into two worked in small groups to highlight 2) To get to know the roles and groups of 12-14. Each group key lessons learned. responsibilities of community visited a different field site. They health promoters and how were each accompanied by a they coordinate with health WN- East Africa staff person and facilities. local staff. The committment of the traditional The extensive record keeping birth attendants (TBA)is impres- that the TBA maintains in sive. Payment for services is not Kenya would not be possible compulsory. Sometimes they have in West Africa, where to pay from their own pocket to illiteracy is a problem. buy supplies for their kits. The community trainers in Kenya They gave me a clear picture of are impressive. Despite an unclear the goal of the community phar- focus, the high price of medicine and macy, which is to provice services only minor incentives, the Trainer of nearer to the house. From their Trainers remain highly motivated. income they are able to do devel- opment work. WNIA SPRING/SUMMER 2003 SUBJECT: INTEGRATING REPRODUCTIVE HEALTH
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