Improving SRH for Rural Adolescent Women in the marginalized areasSummary Improving Sexual Reproductive Health for rural adolescent women in the marginalized areas of Rumphi, Mzimba north and Chitipa districts of Malawi is a project implemented by DAMRA Malawi with funding from CORDAID to empower communities in the projects catchment area so that the health system is more responsive to Adolescent SRH, there is an increase in access to Youth Friendly Sexual and Reproductive Health Services and increased access to family planning and ensure there is quality reproductive health care Goals and Indicators
The overall goal is to contribute to the improvement of sexual and reproductive health of Malawi’s youth in the context of gender equity, sexual and reproductive rights and improvement of maternal health as outlined by MDG 5. Goals o 36 health workers trained o 12.000 adolescents reached with SRH activities o 18 health centers have become youth friendly Indicators o 36 Healthcare staff members trained o 12000 People receiving improved quality care o 18 Institutes with increased quality services Background According to the 2006 Malawi Multiple Indicator Cluster Survey (MICS 2006), in Malawi, women aged between 15-19, one in every three adolescents has started childbearing, 8% are pregnant with the first child and 27% have had a live birth. More than half of adolescents (53%) aged 18 have begun childbearing and amongst those aged fifteen, 6% have begun childbearing. More than half of adolescents aged 19 (60%) are mothers compared to 3% of those aged 15. Overall, 14% of girls aged 15–19 have had sex before age 15 while 65 percent of women aged 20–24 have had sex before age 18. Only 40% of women and 58% of men use a condom with non-marital, non-cohabiting partner. This increases the chances of young women as well as their male peers of contracting HIV and unplanned pregnancies (Multiple Cluster Survey 2006). Teenage pregnancies, cultural taboos encompassing sexuality along with sexual and reproductive health misconceptions held in the population (40 %+) have caused a high school dropout rate which consequently leads to underdevelopment of the already undeserved marginalized areas. Initial Situation DAMRA has been working in the marginalized areas of Rumphi since 2004 and found no previous Programs focusing on SRH. The District Health offices in the districts where we implement the project had SRH programmes in some but not all health centres. Not until this intervention, there were no youth friendly centres in the project areas where youths could access information from fellow youths on SRH. Overall Objective Contributing to the improvement of sexual and reproductive health of Malawi’s youth in the context of gender equity, sexual and reproductive rights and improvement of maternal health as outlined in MDG 5. Target group The direct beneficiaries are young people, in and out of school, in the age of 12 to 24 years with low educational levels, inadequate knowledge regarding SRH issues and limited access to SRH services. Other direct beneficiaries are the parents (mothers and fathers) and key members of the communities (such as religious leaders, community leaders, and teachers) who can have an important positive or negative influence on SRH behaviors of young people. The project is also working with health staff from the public and private service providers, school, village and health committees who are benefiting from the training efforts and increasing their capacity to attend young people. Project Plan Specific Objectives and Activities 1. To promote participation, social mobilization and empowerment of the community to achieve comprehensive sustainable changes and solutions and make the health system more responsive to the SRH problems young people face. There has been a communication and education campaign directed towards the community (parents, young people, community leaders, teachers) targeting those actors who have the potential to influence community norms, behavior, and socio-cultural factors that affect the SRH of young people. The campaign has emphasized the acquisition of skills by the community which are necessary to develop critical thinking, to promote community dialogue and collective action in social-change processes; community capacity as an organizing construct for community-involvement interventions; and initiate social action to obtain changes within the community to create an enabling environment that influences choices available to youths and related decision-making on SRH. 2. To provide comprehensive information, sex education based on the development of skills, abilities and positive life values regarding family planning methods and seeking health care. To develop a comprehensive sexuality education; iterative learning methods, discussion and reflection is being used, instead of the paradigm of teaching and imposing knowledge and norms. This is promoting a different form of learning whereby young people develop their own values and attitudes, learning from each other and involving their communities. The activities are providing young people a framework which is facilitating them to learn about their sexual and reproductive rights; acquire information to dispel myths; gender issues; provide references to resources and services in health and education; obtain skills in communication, negotiation, self development, decision-making; and develop a sense of self, confidence, assertiveness, capacity to take responsibility, ability to ask questions, seek help and a sense of responsibility. 3. To contribute towards improved quantity or quality of reproductive health services and youth friendliness of SRH services for young people in the pre-pregnancy phase through the Coupon system. The project has establish appropriate confidential youth-friendly SRH health services and make these services more accessible, especially to youth who need them most. This will be done through the development of a competitive SRH Coupon program, which has furthermore strengthened the capacity of staff of service providers (public, private-non-profit or private-for-profit) in providing quality, appropriate and timely care. The scheme has the potential to target specific segments of the population effectively and provide them with priority services such as family planning. The project has also provided training of health staff of participating providers to raise awareness about the SRH needs of young people and improve their knowledge and technical and communication skills to prepare health staff to provide quality, youth-friendly, confidential, accessible SRH services consistent with the needs of young people. Sustainability Developing a community’s capacity to solve problems related to ASRH requires action at the individual, institutional and social level. While communities may not have much experience addressing ASRH-related issues prior to an external organizations’ involvement, communities can develop ASRH capacity over time. It is just as important to assess a community’s capacity to address ASRH and other health issues, as it is to survey adolescent knowledge, attitudes and practices, and to document the availability of youth services. DAMRA believes that a capable community that supports an enabling environment for youth will foster both individual and institutional change. The proposed project will therefore dedicate much of its activities to equipping the beneficiaries with skills that will enable them to share sexual reproductive health and rights messages with fellow citizens in communities other than the core project impact areas. The knowledge imparted to the local communities through the project will make them appreciate maternal health issues and participate in demanding quality reproductive health service delivery. Community trainings by the project have also focused on strengthening the management capacities of the community so that they can collectively manage the operations of the project without any outside support. DAMRA has been closely working with the District Health Office (DHO) through Community Health surveillance Assistants (HSA) who have been trained together with health personnel in youth friendly health services provision but they have been incorporated in the project activities as patrons and advisers for all the established SRH youth clubs. The HSA’s in collaboration with the youth club leaders are coordinating the activities of the youths in the SRH clubs. This relationship is providing the necessary link between community youths and the local health facilities where the youths are getting the Youth friendly health services. The relationship is thus instilling confidence in the youths to access reproductive health care and ensure sustainability of the project activities. The youths in all project established clubs, led by the community peer educators, will be trained and empowered to organize and carry out outreach activities by themselves. This will ensure practical experience in organization and management of SRH activities after the project funding ends. A minimum budget has been allocated for such events to support the youth clubs during the project period as they learn how to conduct the SRH outreach activities. Acknowledgements
The projects running state is largely a direct result of constant support and communication from/with CORDAID, DAMRA workforce's timely input, Ministry of Health (Malawi) through Hospitals in the projects catchment area, Local Government, Local Authority, Board of trustees, the general public and the youths that show constant interest to learn more so that they can better their lives and consequently transform their local areas to a better standard of living. |
Project Details Status: Active Project Period: August 1, 2013 – August 30, 2015 Funding: CORDAID Implementing Partners: Ministry of Health (Rumphi District Hospital, Katowo, Chitimba, Bwengu, Thunduwike, Nthalire and wenya Health Centers). Private Hospitals (Hewe and Wongani Private Clinics) |