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Phase: Final Evaluation

Rise Together

Building family resilience through economic empowerment, healthy timing and spacing of pregnancies, and gender equality

Photo of Lauren Van Enk
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*Please Upload User Experience Map (as attachment) and any additional Beneficiary Feedback in this field

“During the couple counseling sessions we share challenges and experiences, so from there the non-family planning users can learn how the method works and the advantages. In groups we can learn new things since there will be views from different people.” (Male FAM user) “It created harmony among us in the community including the elderly women alike; they often attended our sessions and invited their daughter in-law to take up family planning.” (Female Youth Facilitator)

Explain your project idea in two sentences.

Youth-led livelihood groups increasing social support and skills for family resilience through family planning and community reflection and dialogue.

What is your organization name? Explain your organization in one sentence.

IRH translates scientific data into simple, scale-able solutions for global health challenges.

Is this project idea new for you or your organization? If no, how much have you already executed on?

We’ve undergone formative research and proof of concept testing. Implementation of the test period is winding down, and we’re seeking to improve the design based on users’ experience. We've identified the need for additional focus on violence prevention and skills building for livelihood groups.

What is the problem you aim to solve with this idea? How would you define this problem as urgent and a priority in your target community?

Rise Together seeks to help address the damaged social institutions (particularly gender inequality) and economic opportunities as a result of the LRA conflict; the overburdened health system and social/cultural barriers leading to nonuse of FP, and the lack of income generating skills among youth.

What is the timeline for your project idea? What are the key steps for implementation in the next 1-3 years?

We will use a phased expansion approach over the course of 3 years where each pair of youth facilitators implements the program in one village every 6 months. Depending on resources, a group of 25 youth facilitator pairs could cover 50 villages within two districts in Northern Uganda in a year. At that point, we would consider incorporating into the approach a mentoring component where current youth facilitators mentor new youth facilitators to take on and expand the activities even further.

Describe the individual or team that will implement this idea (if a partnership, please explain breakdown of responsibility).

Youth Livelihood Programme is a loose network of groups in Uganda under the coordination of local Community Development Offices. Groups are led by and serve Ugandan youth ages 18-30. YLP groups will be invited to participate in the intervention alongside IRH according to defined selection criteria.

What do you need the most support with in this project idea?

  • Program/Product/Service Design

What is your primary goal over the next 6 weeks of Refinement?

  • Try something different, new or scary :)

How do you currently measure (or plan to measure) results for this project?

Key outcomes of the intervention are increased access to voluntary family planning services, improved attitudes around gender equality, and improved capacity among YLP groups--ultimately leading to improved family resilience in the region. We plan to measure the effects through a baseline/endline community survey, interviews with participants and stakeholders, and collection of health service statistics throughout the project life cycle.

How has your project proposal changed due to your user research during the Beneficiary Feedback Phase?

According to challenges voiced by users in the pilot, Rise Together will focus more efforts on the youth livelihood group that youth facilitators belong to which should strengthen the motivation of facilitators as well as improve their their livelihood skills. The invitation card for family planning will also be improved so that community members will receive the services they need.

(Optional) What are some of your still unanswered questions or concerns about this idea?

We are proposing a new mentoring component which will allow current youth facilitators to mentor new youth facilitators in the intervention activities. We’d like to know more about how both new and original facilitators would perceive this activity.

Global poverty is perpetuated by a complex constellation of factors and must be addressed by integrated, contextualized, and community-owned solutions. Rise Together seeks to disrupt the cycle of poverty by building family resilience through economic empowerment, access to information and services for healthy timing and spacing of pregnancies, and improved gender equality.

This need is more salient in a post-conflict setting like Northern Uganda where social institutions and economic opportunities were damaged by civil strife. The conflict between the Ugandan government and the Lord’s Resistance Army led to massive disruption of health services, internal displacement of people, the erosion of traditional social and family structures, and a generation of young people who have grown up surrounded by violence. In the aftermath of the social disruption and violence, communities are striving to rebuild social and family structures, many of which socialize youth into adult roles as productive community members. It is critical to support local leaders and communities to revitalize positive elements of cultural traditions in a gender-equitable way as they navigate the post-conflict context.

In Uganda, despite investments in reproductive health over the last decade, high rates of unmet need for family planning remain. Uganda has one of the highest teenage pregnancy rates (25%) in sub-Saharan Africa (Uganda DHS 2016). Especially in remote or low-resource settings, access to information is lacking, health systems are often overburdened, and family planning counseling may be out of reach. The West Nile (43%) and Acholi (39%) regions in Northern Uganda have the highest unmet need for family planning in the country (Uganda DHS 2016). The use of family planning for healthy timing and spacing of pregnancy can dramatically improve the health and survival of both women and children. Pregnancy among young girls or among mothers with closely spaced births increases the risk of morbidity and mortality for mother and child. Not only are these grave consequences in and of themselves, but they can also be economically devastating. Family planning allows women the opportunity to complete school, pursue livelihood opportunities outside the home, and plan the number and spacing of her children.

An intervention that combines investment in economic opportunities and access to family planning can address the critical obstacles which keep young people from flourishing in life. Moreover, gender equality must be an explicit cross cutting strategy in all activities to overcome the violence and limited opportunities that women and girls face.  

Explain your idea

Rise Together works with existing livelihood groups to improve access to FP and address gender equality. Members of these groups are selected by their own peers as youth facilitators, and they work in pairs (male and female) to lead their communities in learning sessions on topics like body literacy, gender equality, healthy timing and spacing of pregnancies, and FP. They offer group counseling sessions for couples interested in FP, particularly fertility awareness methods. Using a group setting can help increase acceptance of method use and fill a critical gap in underserved populations. The project will also strengthen the groups’ existing capacity in economic empowerment through additional training and resources to expand their reach. Finally, local stakeholders like religious leaders are engaged throughout the process as key champions of social change through sensitization workshops so they are able to mobilize the community to invest in their health and wellbeing. Rise Together addresses each focus area of the BridgeBuilder initiative--peace, prosperity, and the planet. Peace: This intervention seeks to address drivers of gender-based violence through engaging in open discussion and reflection about gender norms within community learning sessions, supporting couples to improve communication and shared decision making, and equipping religious leaders to tackle gender injustices in their denominations and communities. Prosperity: Restrictive gender norms, enforced by both men and women, prescribe that women are primarily responsible for childbearing and household chores and are subordinate to men. The situation is starker for young women as they face pressure to marry early and begin childbearing with few alternatives such as education and employment. Creating a supportive environment where it is acceptable and feasible for women to access market opportunities can improve families’ financial stability. When individuals are more financially stable, not only can they provide for the needs of their family, their attitudes and behaviors around planning for their future improve. Economic opportunities and access to FP go hand in hand as they give women tools to plan for her future ultimately improving the wellbeing of her family and the community. Having fewer children per family leads to more household savings and increased investments in each child. Planet: Uganda is struggling to ensure sustainable and equitable development in remote rural areas where subsistence farming is no longer a viable livelihood. The poorest citizens are often living in the most fragile contexts as they depend directly on nature to meet their basic needs yet those natural resources are dwindling. Directly helping families to plan the number and timing of their children can reduce the negative impact of this resource scarcity.

Who Benefits?

The primary target population is women, men, and couples 15-35 years in Northern Uganda. Expected outcomes for this population are increased access to voluntary FP services, improved attitudes around gender equality, and improved capacity among microfinance and livelihood groups--ultimately leading to improved family resilience in the region. An intervention that combines investment in economic opportunities and access to FP can address the critical obstacles which keep young people from flourishing in life. Moreover, gender equality must be an explicit cross cutting strategy in all activities to overcome the violence and limited opportunities that women and girls face.

How is your idea unique?

Aspects of this intervention have been piloted and have shown that the group learning & counseling approach with microfinance groups can have positive effects on knowledge, attitudes, and behaviors related to gender and reproductive health. The original intervention was grounded in human centered design, beginning first with formative research and tested in a proof-of-concept phase to ensure relevance and feasibility in the local context. Furthermore, this intervention recognizes and works with social and cultural institutions at the community level. Local stakeholders like religious leaders have the power to increase significantly the demand for and use of health services and change harmful social norms. Faith is an important determinant of value systems, at both the individual and community levels.

Idea Proposal Stage

  • Piloting: I have started to implement my solution as a whole with a first set of real users.

Tell us more about you

The Institute for Reproductive Health (IRH) is part of Georgetown University’s Medical Center. IRH has over 30 years of experience in designing and implementing evidence-based health solutions, translating scientific data into simple and practical guidance for clinic- and community-based programs. As an expert in global reproductive health, IRH focuses on essential issues such as gender equity, couple communication, scale-up of innovations, building country-led capacity, fertility awareness, and addressing needs across the life course for both men and women. IRH also collaborates with Muslim, Catholic, and Protestant FBOs seeking to strengthen their healthcare services. As a result, many of our past partners have achieved sufficient capacity to be resource organizations, providing training to partners and, in some instances, assisting public sector programs in integration of services. IRH is based in Washington, DC and partners with local implementers around the world. In particular, we have worked in Northern Uganda for seven years. Elements of the intervention described in this submission were first developed in partnership with Save the Children and alongside independent community-based microfinance groups in Northern Uganda where it was given the local name “Wake ki Lago Nywal” or WALAN. Based on the successful pilot testing results, IRH believes that this intervention can be modified to more strongly address outcome areas like gender equality and economic empowerment. IRH proposes to first identify several local organizations in Northern Uganda with demonstrated capacity. Based on defined selection criteria, IRH will partner with one of these local organizations to manage intervention implementation. Microfinance and livelihood groups will be selected from among existing groups in the region. IRH will provide technical assistance in training, monitoring, and evaluation of the intervention. www.irh.org

Expertise in sector

  • 7+ years

Organization Filing Status

  • No, but we are a formal initiative through a university.

Attachments (1)

Rise Together User Experience Map.pdf

9 comments

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Spam
Photo of OpenIDEO
Team

Hi Lauren and Team! We’re excited to share with you feedback and questions from the BridgeBuilder team and an external set of experts. We encourage you to think about this feedback as you continue to improve and refine your idea. You are welcome to respond in the comments section and/or to incorporate feedback into the text of your idea. Your idea and all associated comments will all be reviewed during the final review process.

Based on expert career, work and experience, is this a new approach or bold way of answering the challenge question:
• This proposal looks very similar to the 5-year $5.5M grant Georgetown's IRH program got from USAID in 2013. What is "new" or significantly different with this grant vs the 2013 USAID grant? Is this basically an extension of the USAID grant? What have you learned from the 4 years you have had the USAID grant? I have tremendous respect for Georgetown's Global Health Initiatives and especially their intentionality to work in Northern Uganda.
• The proposal is clearly based on existing programs and projects that have proved successful in similar contexts. That said, it would benefit from a greater emphasis on how this is new or different-- what is this program doing that hasn't been addressed by similar programs? What will you be testing or iterating on during the course of your work?

Desirability and Viability of proposal:
• Desirable: This program seems very similar to the USAID grant, 2013. If so, I assume you have had some positive outcomes and now want to extend and perhaps somewhat extend or make some adjustment to these ongoing programs. Would be helpful to have more clarity on whether or not these programs are sustainable, after 5 years of the USAID grant. Would love to know if this is a new program or an extension of an existing program (via existing USAID grant).
• While the project seems both desirable and feasible based on the overview here, more details about the planned project implementation would strengthen your proposal. For example, how will the program take religious and social norms into account? How will you measure success-- do you have any established targets or indicators? How does this program compliment or fit into the larger context (for example, does it align with or build on MoH, UNICEF, or Save family planning or reproductive health programs, etc.?)

Feasibility of proposal (is this an idea that could be brought to life?):
• It seems that this basic program has been underway with the 5-year $5.5M GREAT (Gender Roles, Equality and Transformation). If the USAID grant has gotten good results and there is a "radical new way" or innovative element to the USAID grant you wish to pursue then we should bring it to life. If it's more of an extension of the existing USAID grant with no significant changes being made moving forward then it is not likely "new" and may be less compelling.
• The proposal would benefit from additional detail, including clear targets. It would also benefit from strengthening the innovation piece-- how is this new or different? How will you innovate over the course of the project? Is this more about information delivery, or is it also about behavior change?

Other questions or suggestions our experts felt would support the assessment or success of your idea:
• Strong proposal. Would be helpful to see the specific ways this grant proposal is different from the 5-year $5.5M grant from USAID in 2013.

In case you missed it, check out this Storytelling Toolkit for inspiration for crafting strong and compelling stories: http://ideo.to/DXld5g Storytelling is an incredibly useful tool to articulate an idea and make it come to life for those reading it. Don’t forget - June 16 at 11:59PM PST is your last day to make changes to your idea on the OpenIDEO platform.
 
Have questions? Email us at bridgebuilder@ideo.com.
 
Looking forward to reading more!

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Spam
Photo of Lauren Van Enk
Team

Funding for the design and proof of concept testing phase of RISE Together initially came from USAID through the Fertility Awareness for Community Transformation Project (2013-2018). Initial results show that non-healthcare providers like YLP group facilitators are able to offer community learning sessions on key topics like fertility and child spacing and provide family planning counseling in group settings. These results were assessed after an 11 month intervention period. With these fresh results, the team seeks to strengthen the emphasis on livelihood skills for group members and gender equality so that couples will have the information, skills, and access to services that allow them to plan and support their families.

RISE Together draws on learnings from the Gender Roles and Equality Transformation (GREAT) Project, a recently ended USAID-funded project in Northern Uganda. The GREAT Project’s approach was to address and transform harmful social norms related to gender, violence and reproductive health in Northern Uganda through a toolkit of interactive games, a radio drama, and critical reflection with adolescents (10-19). RISE together benefits from this experience by learning from formative research and social and behavior change approaches established by GREAT. However, RISE together targets an older audience of youth which in Uganda is defined as 18-30. This group of men and women are entering critical transition phases in their life such as marriage and parenthood. In order to address systemic poverty, these couples need the information, skills, services, and social support to decide when to have children and how to provide for them.

RISE Together is a solution design that has undergone proof of concept testing and initial pilot testing in Northern Uganda. Based on these results, the team sees a need for further iteration to enhance the connection with livelihoods and build the capacity of YLP groups as they also address concepts of healthy timing and spacing of pregnancies and gender equality. RISE Together is the first group counseling intervention for family planning conducted outside the formal health system. There is strong evidence documenting the impact of expanding access to family planning to the community level, but there is little evidence showing the feasibility of offering these services in a group of multiple clients. Group counseling for family planning has the potential to address social barriers to uptake, encourage correct method use through social support, and maximize the provider-client counselling time in a setting where family planning counseling is just one of many responsibilities performed by the provider. Small scale service delivery initiatives suggest fertility awareness methods (FAM) can be taught in a group setting, even in contexts with low literacy. In the context of low resource settings—where women may not have access to health services —a group learning approach meets both the local need and cultural context for sharing key information. As FAM are information-based and natural family planning methods, disseminating information about the methods and facilitating potential uptake is possible within group settings, unlike other family planning methods. Therefore, increasing access to and use of FAM through existing groups and social networks offers a unique opportunity to go beyond the health system to address unmet need for family planning in areas that desperately need services. FAM options are included in the government of Uganda’s family planning norms and are considered modern by WHO and USAID. Linkages with the formal health system will continue to be emphasized through orientations with facility staff and the provision of family planning invitation cards during RISE Together community learning sessions.

As part of the monitoring and evaluation plan, provider competency in method counseling, correct use of methods by clients, and overall uptake of family planning is assessed. In subsequent iterations of the design, the team would like to conduct a community survey to measure broader social change and improvements in well being from the intervention, e.g. gender equitable norms, family planning attitudes, economic security, food security, and community participation. Relationship dynamics (e.g. shared decision making, communication, partner support, etc.) will be assessed among couples who participate in group learning sessions and take up a method of family planning.

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Spam
Photo of Kate Rushton
Team

Hi Lauren Van Enk 

If you have any questions on the expert feedback, please feel free to reach out to us on bridgebuilder@openideo.com.

Also, are there are any types of organisations for this project or in general you would like to be connected to?

I am tagging some people here who may have feedback to share on your project based on their knowledge of reproductive health Emily Bishop Carly Clark @DeletedUser Isabel Shaw Emma Sacks 

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Spam
Photo of Jeff Richardson
Team

Could you please help me understand how this proposal is new and different from the 5-year $5.5M USAID grant you got in 2013 entitled the GREAT (Gender Roles, Equality and Transformation) Project? Thank you.

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Spam
Photo of Linda Caste
Team

I believe that this is a great idea. In my opinion, you need to involve the local leaders from the beginning for a faster development of the idea in the community.

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Spam
Photo of eldy wullur
Team

In my area of gender equality is already hundreds of years we enjoy, so also with regulate the distance of pregnancy and even now the government has advocated to add more children, because the population has been greatly decreased, because in one family generally only have 2 children. But the economic empowerment of the family, that's what we're striving for. Generally in a family only dads who work and make money while others just spend money. Salute for you who fight for that 3 things at once ..

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Spam
Photo of Lauren Van Enk
Team

Hi Kate, Sheku, and Vicki,

Thanks so much for your interest in and contributions to this project!

Kate and Sheku, you asked where we think this project will be in the near future. Great question. Right now, this project has gone through proof-of-concept and a small pilot testing phase. It’s showing promising results so far, especially around improved knowledge, positive attitudes around healthy timing and spacing of pregnancies, and increased uptake of family planning. Youth facilitators from the microfinance/livelihood groups reach out first to their village members with the community learning and group counselling sessions. They were able to achieve coverage of their village over the course of a few months. Ideally, the activities would be expanded to other villages once the majority of community members were reached. We would expect that each pair of youth facilitators could easily cover a village every six months. Depending on resources and project time frame, a group of 25 youth facilitator pairs could cover 50 villages within two districts in Northern Uganda in a year. We would also like to incorporate into the approach a mentoring component where current youth facilitators mentor new youth facilitators to take on and expand the activities even further. It’s important to note that the youth facilitators are volunteers so expectations for such activities need to be manageable within their daily activities in order for the model to be sustainable.

Sheku, your work sounds really valuable. We completely agree with the importance of male involvement and recognize that women’s decisions are never made in isolation. Your questions about male involvement and cultural acceptability are key. We strive to include both men and women in our work, especially considering that areas of reproductive health and women’s empowerment often focus solely on women. The microfinance/livelihoods groups are co-ed themselves which encourages a collaborative rather than competitive environment for economic empowerment. Rise Together uses a pair of youth facilitators - one male and one female - to more easily engage both sexes during community learning sessions and group counseling. Another major component of the project is stakeholder involvement, particularly religious leaders. Religious leaders and other influential cultural leaders will be invited to participate in sensitization workshops where they will be equipped with information and skills on gender equality, family planning, and couple communication. After engaging in critical reflection and dialogue on these issues, they’ll return to the community with new information and perspectives to share with their followers. They’ll be included in routine intervention activities and asked to share their perspectives along the way.
In the pilot testing phase, Community Development Officers in the district were also oriented on the approach which allowed for local ownership and enabled them to provide supportive supervision to the youth facilitators. They also supported linkages with health facilities so that youth facilitators could offer referrals for health services when needed.

Vicki, in our design and pilot testing phase we worked very closely with Save the Children to implement these activities. The local microfinance/livelihood groups were selected from among existing, self-governed groups in Northern Uganda who agreed to participate. During the pilot-testing phase, we worked with these groups to incorporate topics like body literacy, healthy timing and spacing of pregnancies, and gender equality. Based on this experience, we believe that the intervention could be even more robust by strengthening areas around gender equality and investing in the current activities of the microfinance/livelihood groups. Economic empowerment is a combination of power and agency as well as economic advancement. Power and agency are consistently addressed across each component of Rise Together from community learning sessions where harmful social norms are identified and discussed to supporting women to plan and space their births. We envision that economic advancement is possible though strengthening both human and financial capital of community members. Vocational training in entrepreneurial skills, the use of new technology, or the management of assets like livestock would improve human capital. We will also seek to extend the reach of microfinance opportunities to additional villages using the mentoring approach mentioned above to further support financial capital.

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Spam
Photo of Sheku Gassimu
Team

Excellent!!
Thank you for posting your ideas. Where do you see the project in 5years? Do you see husbands and village authorities supporting this? How do you intend to pass this ideas across cultures or people of different religious background.

I work with Onevillage Partners in rural Sierra Leone. We have a program Nurturing Opportunities for Women (NOW). The program is about training women on financial planning. With the trainings provided, our participants make informed choices over their individual lives through supports from their husbands and other participants in the group. Women are expressing how they now have voice and control over their finances. We are also seeing husbands coming forward to explain how they are supporting their wives in achieving their financial goals. We actively involve the husbands in our gender model sessions, where they are taught on the needs of sharing household roles. Because we are more participatory with our approaches, traditional authorities are also very supportive to the program. 
Thanks and good luck!

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Spam
Photo of Kate Rushton
Team

Hi Lauren!

Welcome to the challenge. Thank you for posting your project.

Is this the website of your organisation - irh.org? If it is, would you consider including it in your submission post?

Where do you think this project could be in 1, 2 or 3-years time?

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