An Adolescent-inclusive SRH needs assessment

Location:

Introduction:

DRCDemocratic Republic of the Congo’s reproductive health outcomes are among the poorest in the world. As of 2014, 27% of older adolescents (age 15-19) had begun childbearing: 21% were already mothers and 6% were pregnant. In the crisis-affected region of North Kivu, women and girls face even greater challenges. CARE’s baseline survey of 709 adolescents and youth found that 32% of all surveyed girls aged 15-24 years were ever pregnant; of those who were pregnant, 29% got an abortion. As adolescents and young people in Goma City and its neighboring areas have grown up surrounded by crisis, this project aimed not only to address their SRHSexual and reproductive health needs but also to provide them with the opportunity and agency to create change for themselves and their community.

Project Description:

The DFIDDepartment for International Development-funded Aid Match project Vijana Juu (Swahili for “Up with youth”) was implemented by CARE from February 2016 to October 2017. This pilot project built upon CARE’s existing Supporting Access to Family Planning and Post-Abortion Care (SAFPAC) intervention to assess feasibility of including a strong ASRHAdolescent sexual and reproductive health component within the SAFPAC Supporting Access to Family Planning and Post-Abortion Care model to meet the SRHSexual and reproductive health needs of adolescents. The project was implemented in partnership with faith-based groups that manage health facilities and schools in close proximity to each other. CARE project staff, along with a representative from the Ministry of Health’s National Program for Adolescent Health, facilitated workshops with youth from surrounding communities to review baseline assessment results and input into project design. CARE used its Community Score Card (CSC) approach to bring together youth, service providers, and government officials to agree upon 4 indicators that represent quality and accessibility of “youth-friendly services” and to put in place a process for monitoring progress on these indicators and trouble shoot problems related to access and service provision. The project also included adolescent-responsive services training and supervision for providers and a peer model approach. Moreover, the meaningful participation of program participants in designing, adapting, and providing ongoing feedback and an iterative program approach allowed for introducing additional program components such as an adolescent-specific referral card to reduce the waiting time young people face at health facilities. Given the positive feedback on this intervention, CARE introduced core Aid Match interventions (such as orientation of providers to ASRHAdolescent sexual and reproductive health needs, implementation of fun referral cards, and procurement on supplies that meet adolescents’ needs) in SAFPAC Supporting Access to Family Planning and Post-Abortion Care’s other health facilities in Goma, further extending the availability of adolescent-responsive SRHSexual and reproductive health services across 15 health facilities.

Results:

CARE provided contraceptive services to 22,633 new users of family planning across the 15 SAFPAC Supporting Access to Family Planning and Post-Abortion Care sites, including 4,681 new users in the initial 4 Aid Match sites. When excluding condoms as a method of choice, 44.7% of young people across the 15 health facilities and 48.9% of young people across the 4 initial Aid Match facilities chose a long-acting reversible contraceptive (implant or intrauterine device). One hundred percent of adolescents that accessed the CARE supported services through the project were satisfied with the services they received. Sixty young people were trained as peer-leaders/youth mentors and 10 peer-leaders/youth mentors were trained as community counselors, an intervention that was introduced to meet the needs of young people living in IDPInternally displaced person camps and nearby host communities that did not have access to SRHSexual and reproductive health services. Nine community-based organizations (CBOs) were supported to provide community engagement events focusing on ASRHAdolescent sexual and reproductive health, including community dialogues. Overall, 1,742 community dialogues were carried-out to raise awareness not only among young people on SRHSexual and reproductive health but also to support an environment and community dynamics that facilitate their access to SRHSexual and reproductive health services.

Lessons Learned:

Engaging young people through a participatory approach in project research, design, and implementation resulted in adolescent-relevant services and likely higher utilization of SRHSexual and reproductive health services. Qualitative feedback indicates establishing an accountability mechanism through CSCCommunity Score Card provides adolescents the opportunity to share feedback on services that is relevant not only to them but for the community-at-large. Furthermore, the CSCCommunity Score Card approach improved relationships and encouraged dialogue among youth, community leaders and health providers. Based on supportive supervision activities undertaken by CARE staff, we noted that adolescents require additional compassion and support before, during, and after receiving contraceptive methods, especially during the process of identifying relevant long-acting reversible contraceptive methods. It is noteworthy that peer leaders across the 4 sites launched an adolescent network themselves, Vijianna Vision, so as to continue community-level activities beyond the life of the project.