What’s blood got to do with it?

Posted septembre 29, 2020
Impact Area Sexual & Reproductive Health

Leading with menstruation to deliver the whole sexual and reproductive health package for girls in Latin America.

By Andrea Novella, Regional Manager, Social Media, PSI LAC, and Lorena Villeda, Regional Social Media Specialist, PSI LAC

Daniela didn’t understand what was happening to her body the first time she menstruated. Nobody had fully explained what would happen. She had only heard that her period was “dirty,” that on ¨those days, women act crazy¨ and that it was “like being sick.”

She remembered what her mother had once told her— that with the onset of menstruation she must be careful as “boys could be dangerous”–but Daniela never really understood how her periods related to boys. She was curious but struggled to find a trustworthy source of information about her menstrual health and hygiene without being shamed or judged.

Daniela is not alone. Girls across Latin America face similar challenges. The stigma and lack of information around menstrual health prevents them from having a holistic understanding of their sexual and reproductive health and taking charge of their health, their bodies, and their lives.

Girls face a poverty of choice and agency when it comes to their sexual and reproductive health, directly impacting their opportunities for development. Misinformation on the menstrual cycle (including the most fertile days) increases the risk of unplanned adolescent pregnancies, contributing to the high teen pregnancy rates in the Latin America region, where 1 in 4 pregnancies are among underage youth. (Source: 2017, Pan American Health Organization, United Nations Population Fund, and United Nations Children’s Fund)

Changes to menstruation are one of the most frequently cited concerns around using modern contraception. Using the digital tool Social Listening, a software designed to identify keywords and phrases across user content posted on online channels, PSI Latin America conducted an analysis of all public social media conversations around the topic of menstruation and found that one of the top words used in relation to the word menstruation is “contraception”.

BRIDGING THE GAP

When girls don’t understand the whole picture of their sexual and reproductive health, inclusive of their menstrual health, they can’t make the best decisions for themselves and their futures. That’s why PSI Latin America is leveraging technology to increase information and access to sexual and reproductive health (SRH), including menstrual health and hygiene, and contraception for youth. As part of the Youth 3.0 program, PSI Latin America is using youth-friendly brands, such as Úsala Bien (¨Use it Well ¨in Spanish) and Ubi Bot—a digital self-counseling tool powered by artificial intelligence—to provide young people with on demand SRH information through popular digital platforms, such as Instagram, Facebook, and WhatsApp, to take charge of their health in a fun and engaging way. Not only do these digital platforms promote SRH, Úsala Bien and Ubi Bot help connect young people to peer outreach workers who provide online contraceptive counseling and referrals to youth-friendly healthcare service providers.

And menstruation is proving to be a critical way to open the conversation with young people to talk about their sexual and reproductive health.

From January through August of this year, 23 million young people in Guatemala, Honduras, Nicaragua, El Salvador and the Dominican Republic were exposed to PSI Latin America’s health messaging across over ten different online touchpoints, including the Ubi Bot page, which garnered 287.5K direct conversation messages across the region. (Sprout Social, results from Facebook and Instagram January through August 2020). The PSI Latin America team found that content around menstrual health garnered significantly more engagement on their digital platforms. Compared to the 3% standard engagement rate, informational posts about menstrual health had 20% engagement with audiences, increasing the pages’ reach in providing sexual and reproductive health messaging and connecting young people to providers for contraceptive counseling. (source: PSI Technical brief for the Integration of Menstrual Health in SRHR).

TAKING CHARGE OF HER HEALTH

Daniela feels fortunate. Scrolling through Instagram, she found an interesting post about menstruation and fertile days posted on the Ubi Bot feed. There, she discovered a safe space where she could turn for support along her sexual and reproductive health journey. Through videos and articles posted on Ubi Bot´s page, she began learning about her menstrual cycle and how it links to pregnancy, as well as different types of contraceptives. Eventually, after chatting with Ubi Bot on messenger, she was referred to a nearby healthcare provider using her GPS location, where she received a consultation and IUD insertion, an option that she never would have considered before talking to Ubi.

This past weekend we celebrated World Contraception Day, a day on which Daniela’s story highlights the need to continue supporting youth who too often have limited access to menstrual health education and contraception. However, with innovation and technology, we have seen how we can bridge that gap, by reducing stigma and providing access to the information and services for young people to live healthier lives and transform their future.

Banner image courtesy of Flickr/Lon&Queta.

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

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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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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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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.

What’s blood got to do with it?

BRIDGING THE GAP

TAKING CHARGE OF HER HEALTH

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The Consumer as CEO

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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