Final Report Survey 2 Multi-Year Annual Survey to Monitor Programme Effectiveness of the “Improving Reproductive Maternal and Newborn Health (IRMNH) Programme” Sierra Leone Study commissioned by UNFPA July 15, 2016 Laarstraat 43, B-2840 Reet Belgium tel. +32-3-8445930 E-mail [email protected] fax. +32-3-8448221 www.hera.eu Survey 2 / Multi-Year Annual Survey to Monitor Programme Effectiveness of the Improving Reproductive Maternal and Newborn Health (IRMNH) Programme- Sierra Leone hera - ULB - FOCUS 1000 / Draft Report Survey 2 / May 2016 Survey 2 / Multi-Year Annual Survey to Monitor Programme Effectiveness of the Improving Reproductive Maternal and Newborn Health (IRMNH) Programme- Sierra Leone Final Report Survey 2 Multi-Year Annual Survey to Monitor Programme Effectiveness of the “Improving Reproductive Maternal and Newborn Health (IRMNH) Programme” Sierra Leone Consultant Team: Alexander, Sophie Dramaix, Michèle Fele, Dalia Jalloh, Mohamed Jalloh, Mohammad B Jan Franck Labat, Aline Medina, Marta (Team leader) Pratt, Samuel Sengeh, Paul Weber, Lilas Zhang, Weihong hera - ULB - FOCUS 1000 / Final Report Survey 2 / July 2016 i Survey 2 / Multi-Year Annual Survey to Monitor Programme Effectiveness of the Improving Reproductive Maternal and Newborn Health (IRMNH) Programme- Sierra Leone TABLE OF CONTENTS Table of Contents ..................................................................................................................................... ii List of figures ............................................................................................................................................ v List of tables ............................................................................................................................................. v Acknowledgement................................................................................................................................. viii List of abbreviations and acronyms ........................................................................................................ ix Summary ................................................................................................................................................. xi 1 Introduction ..................................................................................................................................... 1 1.1 Background .............................................................................................................................. 1 1.2 Update on literature review .................................................................................................... 1 1.2.1 Topics and methodology ................................................................................................. 1 1.2.2 Family Planning ............................................................................................................... 2 1.2.3 Methodology of RH Surveys ............................................................................................ 3 1.2.4 Effect of the EVD outbreak on health services in Sierra Leone ....................................... 3 1.3 Maternal and Newborn Health in Sierra Leone ...................................................................... 4 1.4 Fertility and Family Planning in Sierra Leone .......................................................................... 5 1.5 The Ebola Virus Disease outbreak and its impact on Maternal, Newborn and Reproductive Health Services .................................................................................................................................... 6 1.6 Update on the IRMNH Programme ......................................................................................... 6 2 Objectives and methodology of survey 2 ........................................................................................ 8 2.1 Objectives ................................................................................................................................ 8 2.2 Indicators to be monitored ..................................................................................................... 8 2.3 Survey components ............................................................................................................... 10 2.3.1 Household survey .......................................................................................................... 10 2.3.2 Health Facility Survey .................................................................................................... 12 2.3.3 Focus Group Discussions ............................................................................................... 12 2.4 Survey questionnaires ........................................................................................................... 13 2.5 Data collection ....................................................................................................................... 13 2.5.1 Training of data enumerators, interviewers and supervisors ....................................... 13 2.5.2 Data collection ............................................................................................................... 14 2.5.3 Data management in the field ....................................................................................... 15 2.5.4 Data analysis .................................................................................................................. 15 2.5.5 Ethical considerations ................................................................................................... 17 3 Findings ......................................................................................................................................... 18 3.1 Characteristics of the population surveyed .......................................................................... 18 3.1.1 Heads of household interviews ..................................................................................... 18 3.1.2 Individual interviews ..................................................................................................... 20 hera - ULB - FOCUS 1000 / Final Report Survey 2 / July 2016 ii Survey 2 / Multi-Year Annual Survey to Monitor Programme Effectiveness of the Improving Reproductive Maternal and Newborn Health (IRMNH) Programme- Sierra Leone 3.1.3 Health facility survey ..................................................................................................... 24 3.1.4 Family Planning clients .................................................................................................. 25 3.1.5 Family Planning service providers ................................................................................. 26 3.1.6 Participants in focus group discussions ......................................................................... 26 3.2 Adolescents and youth: sexuality and access to Family Planning services ........................... 27 3.2.1 Sexuality and Family Planning ....................................................................................... 27 3.2.2 Utilisation of health services ......................................................................................... 36 3.2.3 Questions about payment: rationale and results .......................................................... 38 3.2.4 Use of contraceptive methods during the EVD outbreak ............................................. 38 3.3 UNFPA interventions and adolescents and young population ............................................. 38 3.3.1 Saliwansai ...................................................................................................................... 39 3.3.2 VPEs / attenuation – contamination of specificity of UNFPA interventions areas in survey 2 in comparison to survey 1 ............................................................................................... 39 3.3.3 UNFPA and enhanced CAGS .......................................................................................... 40 3.3.4 Comparing the two interventions (VPEs and “enhanced CAGs”) and change in time .. 40 3.4 The provision of FP services by the public health facilities ................................................... 43 3.4.1 Availability of contraceptive commodities at the health facilities on the day of the facility audit ................................................................................................................................... 43 3.4.2 Without stock-outs of contraceptive commodities in the health facilities in the last six and three months .......................................................................................................................... 43 3.4.3 Combination of Family Planning services being provided ............................................ 45 3.4.4 Equipment items ........................................................................................................... 45 3.4.5 Human resources for the provision of Family Planning services .................................. 45 3.4.6 Management and logistics ............................................................................................ 46 3.4.7 The Family Planning client – provider encounter.......................................................... 46 3.5 Adolescents and youth friendly services ............................................................................... 49 3.5.1 Standards for the provision of adolescent and youth friendly services .......................