Why Invest in West and Central African Adolescents and Youth?

Posted mai 28, 2019

Across Francophone West and Central Africa (FWCA), young people too often face socio-cultural obstacles to accessing comprehensive sexual and reproductive health (SRH) services, where and how they need. For young people in FWCA to have the adolescent and youth SRH choices they want and deserve, we must reimagine how we strengthen the market to reach and serve our youngest consumers, on their own terms.

We invited leaders from across the reproductive health field— donors, implementers and young people themselves—to share their perspective on the importance of investing in FWCA adolescents and youth, and what each visionary is doing to change the landscape for the next generation.

As they share: it’s time to combine our energy and voices to serve the FWCA adolescents and youth who need it the most.

Janet Holt, Program Officer, Global Development and Population Program, Hewlett Foundation “FWCA’s youth are ready to take the lead in determining their futures. Comprehensive SRH information and services are a critical component to ensuring that is possible. It is the funding community’s role to support innovative SRH programs that put youth at the center from the start. Through our support for the Ouagadougou Partnership (OP) and the nine Francophone West African countries in it, we fund the OP Youth Think Tank, the OP Youth Ambassador program for civil society, several youth advocacy efforts and human-centered design program innovations to better reach young people with services they want and need.”
	Aissata Segolene Kodio, Activist and Young Leader, Women Deliver “I am starting a campaign where young girls like me who usually have to work or get married can access quality education and Sexual Reproductive Health (SRH) resources so we can build our own wealth and be able to make our voices heard.”
Jess Jacobs, Philanthropist, Maverick Collective “The importance of supporting SRH efforts lies squarely in the fact that access to contraception for adolescent girls—as well as their adult counterparts—helps countries catalyze economic growth and community development. This is the same whether you’re in West or Central Africa, the U.S., or any other region around the world. Investing in that access in FWCA, and truly investing in the girls and women themselves, means that each person is supported to build the future she dreams of and to see it through, exactly as she planned.”
	Hope Neighbor, Partner Camber Collective “Girls in FWCA pay an especially high price for lack of choice. West and Central Africa has one of the largest youth populations in the world—77 million 15 to 24-year-olds live in the region. Girls have limited choice due to a combination of systemic factors, social norms and challenged service delivery. And girls pay the highest price in the world for their lack of choice, with a maternal mortality ratio of three times the world average.”
Kristely Bastien, Youth Technical Advisor, PSI Côte d’Ivoire “If we are going to invest in youth, we need to be in it for the long haul and we need to be consistent. A youth focused meeting? Great. Youth on staff? Great. Inviting youth to work on program design, implementation and monitoring? Great. But not enough. Let’s ask: How frequently are we doing this? And are we being consistent?”
	Nicolette Van Duursen, Francophone Africa Director, Ipas “There are more than 1.8 million unsafe abortions in West Africa each year. Unsafe abortion is the most neglected and easily addressable health crisis for young people. Ipas Francophone Africa uses user-centered design to not only understand what women and young girls want out of self-use interventions, but to also support community health workers and providers in providing high-quality safe abortion services to young women. Through Ipas’ Values Clarification and Attitude Transformation interventions, we work toward ensuring that every young women and girl is able to access comprehensive abortion and contractive care without fear or stigma.”
Nicole Cheetham, Director International Youth Health and Rights Division, Advocates for Youth “In FWCA, adolescents experience some of the highest levels of child marriage, adolescent pregnancy and maternal mortality in the world—yet resources to support their vulnerabilities fall short. It’s time to invest in youth leadership, strengthen and expand promising and effective models and support innovation to advance SRH and rights.”
	Nomi Fuchs-Montgomery, Deputy Director for Family Planning, Bill & Melinda Gates Foundation “By listening to what matters most to young people, we can test holistic models that include expanding method choice, addressing provider bias and supporting gender transformative interventions. Based on insights, we are building evidence to scale in the region so the connection between their reproductive health and personal ambitions go hand in hand.”

Join these women and others at the side event, “Youth-Powered Investments in West and Central Africa” as they discuss what it means to invest in the future of adolescents in FWCA on Monday, June 3 from 12:00-2:00pm in the Fairmont Waterfront Hotel’s Princess Louisa Room.

This article appears in PSI’s Impact magazine, released in tandem with Women Deliver 2019, as part of an ongoing conversation about putting #PowerInHerHands.

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

By: Fana Abay, Marketing and Communications Director, PSI Ethiopia

In rural Ethiopia, women and girls often face significant barriers in accessing healthcare facilities, which can be located hours away. Moreover, there is a prevailing stigma surrounding the use of contraception, with concerns about potential infertility or the perception of promiscuity. To address these challenges, the Smart Start initiative has emerged, linking financial well-being with family planning through clear and relatable messaging that addresses the immediate needs of young couples—planning for the lives and families they envision. Smart Start takes a community-based approach, utilizing a network of dedicated Navigators who engage with women in their localities. These Navigators provide counseling and refer interested clients to Health Extension Workers or healthcare providers within Marie Stopes International-operated clinics for comprehensive contraceptive counseling and services.

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Building community health worker capacity to deliver malaria care

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For example, in Mali, access to formal health services remains challenging, with four in ten people living several miles from the nearest health center, all without reliable transportation or access. In 2009, the Ministry of Health adopted a community health strategy to reach this population. The U.S. President’s Malaria Initiative (PMI) Impact Malaria project, funded by USAID and led by PSI, supports the Ministry with CHW training and supervision to localize health services.

In 2022, 328 thousand malaria cases were recorded by CHWs); 6.5 thousand severe malaria cases were referred to health centers, according to the national health information system.

During that time, the PMI Impact Malaria project (IM) designed and supported two rounds of supportive supervision of 123 CHWs in their workplaces in the IM-supported regions of Kayes and Koulikoro. This included developing and digitizing a standardized supervision checklist; and developing a methodology for selecting which CHWs to visit. Once a long list of CHW sites had been determined as accessible to supervisors for a day trip (including security reasons), the supervisors telephoned the CHWs to check when they would be available to receive a visit [as being a CHW is not a full-time job, and certain times of the year they are busy with agricultural work (planting, harvesting) or supporting health campaigns like mosquito net distribution].

Supervisors directly observed how CHWs performed malaria rapid diagnostic tests (RDTs) and administered artemisinin-based combination therapy (ACT). They recorded CHW performance using the digitized checklist, interviewed community members, reviewed records, and provided on-the-spot coaching. They also interviewed the CHWs and tried to resolve challenges they expressed, including with resupply of commodities or equipment immediately or soon afterwards.

Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact.

In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent.

Supportive supervision with interviews and observations at sites improved the basic competencies of CHWs between the first and second rounds, and additional rounds will help to understand the longer-term programmatic benefits.

Taking a market-based approach to scale sanitation in Ethiopia

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“Rather than relying on traditional aid models that often distribute free or heavily subsidized sanitation products, market-based sanitation creates sustainable and affordable solutions, integrating market forces and supporting businesses to grow.”

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Promoting self-managed care like Self-testing and Self-Sampling

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Here’s how we got there.

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PSI’s first consumer-facing implementation of FHIR was launched in September 2022 as part of the Babylon Symptom Checker project in Vietnam, enabling rapid alignment between PSI and Babylon’s FHIR-enabled client records systems. PSI already has several other consumer health FHIR implementations under active development in 2023, including PSI’s collaboration with the Kenya MOH to launch a FHIR-enabled WhatsApp national health line for COVID-19 health information. PSI will also look to adopt and scale health workforce-facing FHIR-enabled tools, such as OpenSRP2, which will be piloted in an SRH-HIV prevention project in eSwatini in partnership with Ona by the end of 2023.

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By: Anya Fedorova, Country Representative, PSI Angola

The shortage of skilled health workers is widely acknowledged as a significant barrier to achieving Universal Health Coverage. To address this challenge, PSI supported ministries of health to develop a digital ecosystem that brings together stewardship, learning, and performance management (SLPM). The ecosystem enhances training, data-driven decision-making, and the efficiency of healthcare delivery.

Here’s what it looks like in practice.

In July 2020, PSI Angola, alongside the Angolan digital innovation company Appy People, launched Kassai, an eLearning platform that targets public sector health workers in Angola. Through funding from USAID and the President’s Malaria Initiatve (PMI), Kassai features 16 courses in malaria, family planning, and maternal and child health – with plans to expand learning topic areas through funding from ExxonMobil Foundation and private sector companies. A partnership with UNITEL, the largest telecommunication provider in Angola, provides all public health providers in Angola free internet access to use Kassai.

Kassai’s analytics system to follow learners’ success rate and to adjust the course content to learners’ performance and needs. Kassai analytics are integrated with DHIS2 – the Health Management Information System (HMIS) of Angolan MOH, to be able to link learners’ knowledge and performance with the health outcomes in the health facilities. The analytics track learners’ performance by course and gives visibility by health provider, health facility, municipality, and province. Each course has pre-and post-evaluation tests to track progress of learning, too.

By the end of 2022, there were 6,600 unique users on the Kassai platform and 31,000 course enrollments. PSI Angola’s partnership with UNITEL, the largest telecommunication provider in Angola, allows for free internet access to learn on the Kassai for all public health providers in Angola. Building on its success for malaria training, Kassai now also provides courses in family planning, COVID-19, and maternal and child health. This reduces training silos and provides cross-cutting benefits beyond a single disease.

Implementing the SLPM digital ecosystem brings numerous benefits to health systems. It allows for more strategic and efficient workforce training and performance management, enabling ministries of health to track changes in health workers’ knowledge, quality of care, service utilization, and health outcomes in real time. The ecosystem also supports better stewardship of mixed health systems by facilitating engagement with the private sector, aligning training programs and standards of care, and integrating private sector data into national HMIS. Furthermore, it enables the integration of community health workers into the broader health system, maximizing their impact and contribution to improving health outcomes and strengthening primary healthcare.

Why Invest in West and Central African Adolescents and Youth?

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

Building community health worker capacity to deliver malaria care

Taking a market-based approach to scale sanitation in Ethiopia

Promoting self-managed care like Self-testing and Self-Sampling

Using peer coaches to counter HIV stigma in South Africa

simplifying consumers’ journey to care in Vietnam

Engaging the private sector for disease surveillance in Myanmar

Training health workers in Angola

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