This IYD2020, #BeThere for Youth Contraceptive Needs

Posted août 13, 2020
Impact Area Adolescents & Youth

Access to contraception is one of many tools that equips young people with the power to make the decisions that define their lives – even now, during COVID-19.

But with stretched resources amidst programming pivots, COVID-19 has further extended the divide between young people and their ability to make their reproductive health choices.

To serve young people, we need to understand young people – their specific needs and their unique experiences around life in pandemic. Their voices, by extension, must #BeThere, in the room where the programmatic and policy-based decisions happen around the solutions that serve them.

On Aug. 12, young leaders from across PSI, the International Youth Alliance for Family Planning, 120 under 40, Family Planning 2020 and the Self Care Trailblazers Group shared their experiences during the #BeThere International Youth Day Twitter chat – a global dialogue led by youth for youth to discuss young people’s contraceptive needs amidst life in pandemic.

By listening to young people – and by investing in youth skills to build young people’s ability to co-design, implement and advocate for youth contraceptive programs – we, together, can innovate on what it takes to #BeThere with and for our youngest consumers, during and well beyond the pandemic.

After all, young people’s lives – their dreams, their choices– don’t pause for pandemics.

Access to contraception is one of many tools that equips young people with the power to make the decisions that define their lives – even now, during COVID-19.

But with stretched resources amidst programming pivots, COVID-19 has further extended the divide between young people and their ability to make their reproductive health choices.

On Aug. 12, young leaders from across PSI (including A360 Tanzania’s very own Christine Massawe), the International Youth Alliance for Family Planning, 120 under 40, Family Planning 2020 and the Self Care Trailblazers Group shared their experiences during the #BeThere International Youth Day Twitter chat – a global dialogue led by youth for youth to discuss young people’s contraceptive needs amidst life in pandemic.

#BeThere to listen in – catch up on the Twitter conversation here.

Hi all! @ChristinaMassa8 here, a PSI @Adolesents360 Tanzania Young Designer/Youth Officer. Thrilled to be joining the conversation today and taking over the @PSIImpact Twitter handle! #BeThere #IYD2020

— PSI (@PSIimpact) August 12, 2020

Q1: Typically, how do you make choices about your health and body? How has COVID-19 changed your approach? #BeThere #IYD2020 pic.twitter.com/Y4dUi9Lloe

— PSI (@PSIimpact) August 12, 2020

Q2: Since #COVID19 started, what digital tech and/or social media channels do you turn to for trusted #AYSRH information? What gaps have you found in digital access? #BeThere #IYD2020 pic.twitter.com/oKvVv62bX8

— PSI (@PSIimpact) August 12, 2020

Q3: Many of you have told us that privacy is key to making #SRH choices. What does privacy and confidentiality look like for you during #COVID19? #BeThere #IYD2020 pic.twitter.com/PgQuZq2qjy

— PSI (@PSIimpact) August 12, 2020

Q4: Trust is key to inspiring us, young people, to meet with a provider for #AYSRH services. What do you need to feel that you can trust the health system that serves you? #BeThere #IYD2020 pic.twitter.com/nAOO3X0A01

— PSI (@PSIimpact) August 12, 2020

Q5: What are some of the main areas that #AYSRH programs overlook? #BeThere #IYD2020 pic.twitter.com/qDv2ontMf5

— PSI (@PSIimpact) August 12, 2020

Q6: How have self administered #SRH tools – like #HIV self-testing or contraceptive self-injection – supported you during #COVID19? #selfcare #BeThere #IYD2020
A6: Youth can have potential access to expand safe and effective long acting contraception usability pic.twitter.com/YbUjMc4ZBY

— PSI (@PSIimpact) August 12, 2020

Q7: When have you felt most supported to contribute your voice & expertise to design #AYSRH programs? What additional skills would you like to learn? #BeThere #IYD2020 pic.twitter.com/04CPcHU6qK

— PSI (@PSIimpact) August 12, 2020

Q8: During #COVID19 and beyond, what is the 1 thing adults should know about working with young people? #BeThere #IYD2020 pic.twitter.com/TcumuCO5bb

— PSI (@PSIimpact) August 12, 2020

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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.

In a significant development, PSI Ethiopia has digitized the proven counseling messaging of Smart Start, expanding its reach to more adolescent girls, young women, and couples. This approach aligns with the priorities set by the Ethiopian Ministry of Health (MOH) and is made possible through funding from Global Affairs Canada. The interactive and engaging digital messaging has revolutionized counseling services, enabling clients to make informed and confident decisions regarding both their finances and contraceptive choices.

Clients who received counseling with the digital Smart Start tool reported a higher understanding of their options and were more likely to choose contraception (74 percent) compared to those counseled with the manual version of Smart Start (64 percent). Navigators also found the digital tool more effective in connecting with clients, leading to higher ratings for the quality of their counseling.

By December 2023, PSI Ethiopia, working in close collaboration with the MOH, aims to reach over 50 thousand new clients by leveraging the digital counseling tool offered by Smart Start. This innovative approach allows for greater accessibility and effectiveness in providing sexual and reproductive health services, contributing to improved reproductive health outcomes for women and couples across the country.

Building community health worker capacity to deliver malaria care

By: Christopher Lourenço, Deputy Director, Malaria, PSI Global

Community health workers (CHWs) are critical lifelines in their communities. Ensuring they have the training, support, and equipment they need is essential to keep their communities safe from malaria, especially in the hardest to reach contexts.

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

By: Dr. Dorothy Balaba, Country Representative, PSI Ethiopia

In Ethiopia, PSI leads the implementation of USAID Transform WASH (T/WASH) activity with consortium partners, SNV and IRC WASH. Contrary to traditional models that rely on distribution of free or heavily subsidized sanitation products, T/WASH utilizes a market-based sanitation approach. This approach creates sustainable and affordable solutions, by integrating market forces and supporting businesses to grow, while creating demand at the household level.

During the last six years, T/WASH has worked alongside the private sector and government (Ethiopia’s Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills), among other stakeholders, to increase household access to affordable, quality sanitation products and services. For example, more than 158 thousand households have invested in upgraded sanitation solutions with rapid expansion to come as the initiative scales and market growth accelerates.

T/WASH has successfully trained more than 500 small businesses, including community masons and other construction-related enterprises, with technical know-how in sanitation product installation, operational capacities, and marketing and sales skills needed to run successful, growing businesses. The Ethiopian government is now scaling the approach to all districts through various national, regional, and local institutions with requisite expertise. T/WASH has also worked the One WASH National Program, Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills to examine policies that influence increased household uptake of basic WASH services, such as targeted sanitation subsidies, tax reduction to increase affordability, and increased access to loan capital for business seeking to expand and households needing help to improve their facilities.

To share the journey to market-based sanitation, representatives of the Ethiopian Ministry of Health and the USAID Transform WASH team took to the stage at the UN Water Conference in 2023.

“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.

Seven years ago, the landscape of HIV self-testing lacked global guidelines, and only the U.S., the UK and France had policies in place that allowed for HIV self-testing. High disease burdened countries in low-and-middle-income-countries (LMICs) lacked evidence and guidance for HIVST despite major gaps in HIV diagnosis.

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Babylon’s AI symptom checker and PSI’s health provider locator tool captures real-time, quality data that supports health systems to plan, monitor and respond to consumer and provider needs. But for this data to be effective and useable, it needs to be available across the health system. Fast Healthcare Interoperability Resources (FHIR) standard provides a common, open standard that enables this data exchange.
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.

— Martin Dale, Director, Digital Health and Monitoring, PSI

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By: Dr. Zayar Kyaw, Head of Health Security & Innovation, PSI Myanmar

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Training health workers in Angola

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.

This IYD2020, #BeThere for Youth Contraceptive Needs

#BeThere to listen in – catch up on the Twitter conversation here.

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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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