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Increasing access to sexual and reproductive to adolescents at Mishamo refugee camp using Mhealth innovation

We will empower adolescents to make their own decisions by changing norms related to gender, sexuality, early marriage and child bearing

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What specific problem(s) are you trying to address?

The camp experience high population growth ( 3.8% per annual) . Majority of girls are married at age between 15-18 years and 30% of adolescent get pregnant before 19 years (DHIS2015). Less than 8.6 % are using contraceptive methods and about 1 out of 3 adolescents have experience sexual violence.
The leading cause death among adolescent are pregnancy and child bearing complication. They lack awareness sexual reproductive heath and their rights, where to access services and how to prevent and response to sexual abuse.
The government have established group to support income generation for youth groups but lacks capacity to integrating life skills and sexual reproductive health education in the existing groups

Explain Your Idea

Pathfinder will engage with community leaders and influential people to increase awareness and support adolescent to access SRH services. We will use different approaches like adolescent peer groups, community dialogues for awareness creation and engagement of facilities and social welfare office to ensure adolescent can access wide range of SRH services.

Participatory drama will be to sensitize adolescences in the villages to participate in the groups and disseminating SRH messages, promote use of FP and HIV testing and prevention. We will engage the community influential people to discourage early marriage and tean pregnancies.

Peer leaders will receive comprehensive training on provision of contraceptives, gender-equitable, abortion, HIV prevention, GBV, safe abortion, relationships, conservation, human rights and how to facilitate group sessions. They will form groups of 10-15 adolescent and facilitate healthy SRH life skill discussion. These groups will meet monthly. Peer leaders will organize individual session with the member and use mobile App to counsel and offer referral to adolescent to facility or relevant spot for SRH services and link them with existing income generation initiatives by government The mobile application with standard protocol for FP/SRH services and interactive dashboards will be adopted for this idea.
This Peer leaders will be supervised by facility providers for strong linkages with facilities.

Name the three most important ways that your idea will address your identified problem(s).

• Increase uptake of contraceptive services among adolescent groups. This will results in health timing spacing pregnancies and allow adolescent engage in income generation activities for better future prospects

• Implementing this idea will increase awareness to adolescent to various sexual reproductive health issues and their rights. They will be able to recognize any SRH problems they are facing and seek appropriate services and treatments without fear.

• The idea will strengthen linkages and collaboration between district councils, health facilities and communities to support address the need of adolescences. This idea will provide a forum for adolescences to voice their concern with one voice to the government structure

How is your idea unique?

The idea is unique because it has introduce a mobile application innovations protocol to harmonize quality of SRH services offered by different peer leaders providers. Data is collected in real time manner and includes powerful interactive dashboards for displaying results and facilitating data use for decision making. Even the adolescent peer group leaders will be able to use data for session planning.

Peer to Peer education is a common approach but a uniqueness of our approach is the groups will be directly linked to facilities for services through organized community outreach activities. The groups will be linked with income generation activities implemented by the government in the camp area.

Peer leaders will be trained to offer contraceptive services to their peer and will be supervised by health facility staff. We will increase awareness on links of family planning to natural resource management and contribute to sustainable management of forest.

What are some outstanding concerns or questions that you have regarding your idea?

The major concern about the idea is on how we will be able to sustain and scale up the idea

We will use Beginning with end in mind approach to cooperate sustainability component from design. The community and district and region leaders will be engaged from ideation , pilot testing and implementation. We will do regular review meeting to share lessons learned and best practices and advocate for government to scale up of best practices in other refugee camps within the region.

Who are your end users?

About 2500 adolescents age 15-19 years old. They are refugees from Burundi and live at Mashimo camp in Mpanda DC at Katavi region in Tanzania will benefit from this intervention.

Most of the adolescent have little or no knowledge on sexual and reproductive health services and their rights to forge prospect future. They are vulnerable and live in areas with high HIV prevalence. These societies are male dominant and girls have no voice in their society.
We will also organize outreach services these groups were facility providers will offer contraceptives, HIV, GBV services. We will also use interactive drama events to address community norms that prevent adolescent from accessing SRH and their rights.

Where will your idea be implemented?

  • Tanzania

What is the primary type of emergency setting where your innovation would operate?

  • Natural disaster
  • Armed conflict
  • Prolonged displacement

Tell us more about the emergency setting that you intend to implement in

The specific risk are highly populated areas at very remote location. Lack of basic infrastructure, health services and high prevalence of HIV.

This camp is located at Tongwe national forest reserve areas. The area is highly populated and communities relies on forest resources for food security. Regular conflicts exist between the government and community members over village boundaries and sexual and reproductive health and right issues are not discussed openly in these communities.

What is your organization's name?

Pathfinder international

Tell us more about you.

With a mission to champion sexual and reproductive health and rights worldwide, Pathfinder International has placed reproductive health at the center of all that we do since establishment in 1957—Pathfinder has been operating in Tanzania since 1957, with a full-time office established in 1984, focusing on strengthening government and local organizational capacity to improve provision and uptake of sexual and reproductive health and rights services.
We believe sexual and reproductive health care is essential for young people to realize their full potential. Their lives depend on it. Wherever the need is most urgent, our programs ensure young people can make their own decisions about their bodies and choose their own path forward.

Organizational Characteristics

  • International/global organization

What is the current scale of your proposed innovation?

  • Community - 1+ communities within 1 country

Experience in Implementation Country(ies)

  • Yes, for more than one year.

Expertise in Sector

  • Yes, for more than a year.

Organization Location

Pathfinder headquarters is in Dar es salaam Tanzania. We have an office in Mpanda district were the Mashamo refugee camp is located, where we are implementing health and conservation programs.

What is your organizational status?

  • Registered non-profit, charity, NGO, or community-based organization.

What is the maturity of your innovation?

  • Early Stage Innovation: exploring my innovation, refining, researching, and gathering inspiration.

Website

http://www.pathfinder.org/focus-areas/adolescents-youth/

How has your idea changed based on feedback?

The feedback have helped in refining the idea and making the idea very specific and focus. Feed back from users was very helpful to understand the youth have more worries about future plans and than getting SRH services. They need holistic solution that address also their future prospect to get their buy in for seeking SRH services. The government and community leaders have huge concern on early marriage and lack of use of family planning among adolescent and are very supportive with the idea and offer all their support to make the intervention successful. This is a good sign for future sustainability

Who will implement this idea?

The idea will be implemented by Pathfinder staff in collaboration with district staff. Pathfinder have 3 staff at Mpanda district and will provide full time support in implementation. If the idea will be successful we will levarage resources from other pathfinder donors to scale up the idea in all project areas in Mpanda and Kigoma region.

Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?

Pathfinder use HCD design process in developing intervention about youth. we are collaborating with YLab to use develop ideas for addressing provider biases toward serving youth. So the HCD approach is highly recommended by Pathfinder as an organization. The design of this idea involve all senior management team at Pathfinder and they all support the idea.

What challenges do your end-users face? (1) What is the biggest challenge that your end-users face on a day-to-day, individual level? (2) What is the biggest systems-level challenge that affects your end-users?

The biggest challenges end users face is poverty and low knowlege about sexual reproductive health services.

The biggest systems level challenges is lack of youth friendly services in health facilities and staff shortage making it very difficult to access SRH services

Tell us about your vision for this project: (1) share one sentence about the impact you would like to see from this project in five years and (2) what is the biggest question you need to answer to get there?

By end of this project, we expect to reach 80 percent of youth in camp setting with SRH services.

What is it that most attracted you to Amplify instead of a more traditional funding model?

What attracted me to Amplify is the use of HCD approach in designing the ideas and a thorough open feedback process from colleagues and team of experts. This approach bring end user perspectives in the design and provide opportunity to refine the idea and test before implementation.

Do you intend to implement your Amplify idea in refugee camps / temporary settlements?

  • We aim to implement our Amplify idea in a refugee camp / temporary settlement.

How long have you and your colleagues been working on this idea together?

  • Less than 6 months

How many of your organizations’s paid, full-time staff are currently based in the location where the beneficiaries of your proposed idea live?

  • Under 5 paid, full-time staff

Is your organization registered in the country you intend to implement your idea in?

  • We are registered in all countries where we plan to implement.

My organization's operational budget for 2016 was:

  • Between $50,000 and $100,000 USD

What do you need the most support with for your innovation?

  • Program/Service Design

Attachments (1)

Experience Map.pdf

User Experience Map

8 comments

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Team

Hi Hellen and Team!

We’re excited to share feedback and questions from our experts with you.

We encourage you to think about this feedback as you continue to improve and refine your idea, whether that’s refining your idea or adding more context. 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.

- Strengths of this project are its combination of multiple approaches (including peer to peer learning and newer mobile technology) and your clear articulation to use an app platform to link youth to services. Great job!
- You clearly outline your understanding of the deep, contextual difficulties and challenges in this space. How do you intend to deal with these associated risks? What SRH services are actually available for the adolescents, and (if they are referred to them through this project) will they be able to access them?
- Tell us more about your existing partnerships and the strength of relationships you have in this community. Do they share your willingness to engage adolescents in a meaningful way?
- We appreciate your honesty and humility regarding the viability of your idea - this is a great area to explore as you continue to refine your submission!

Some questions to consider:
- Can you state the development status of your mhealth application? Is it already being used in your community?
- How do your intended goals, approach, and implementation plan align? Clarity here is key!
- How will community influencers and gate keepers be engaged to support the changes in adolescents' mindset?
- Can you clarify your point between family planning awareness and natural resource management?

In case you missed it, check out this Storytelling Toolkit for inspiration for crafting strong and compelling stories: http://bit.ly/2uXI0xN Storytelling is an incredibly useful tool to articulate an idea and make it come to life for those reading it. Don’t forget - October 26 at 11:59PM PST is your last day to make changes to your idea on the OpenIDEO platform.

Have questions? Email us at amplify@ideo.org

Looking forward to reading more and thank you for the important work you are doing!

Photo of Hellen
Team

Thanks these are very good comments which will help to refine the idea. You are correct there are many risks facing adolescent in the refugee camp we are proposing to test the idea. We pathfinder implement program in areas hard to reach were others may hesitate to go without fear or boundaries. Pathfinder have a strong presence in the region and we will leverage resources from our integrated Population Health Program ( PHE) we are implementing in the region to continue implementation of the ideas after pilot testing. We are going to engage village and council leaders and influential people in the community for buy in and support since inception. This approach will be critical in addressing the community norms which prevents adolescent from accessing services. The camp is surrounded by four facilities which offer services like contraceptives, HIV counseling and testing, cPAC, GBV screening and support. There is also a gender desk in each police stating offering support to SGBV victims. We will link the adolescent to these services using mobile APP. In fact we will identify a focal person in each service point --i.e facility, police and village social desk to support youth. We have already contacted representive from UNICEF working in the area who are working with district development officers and they have committed to work with us to link the groups with the existing income generation activities in the camp areas.
The mobile Application we are proposing to use have already been developed and we are using to offer SRH services particular family planning in our project in Shinyanga region. We are planning to update and add few modules to capture wide range of SRH services as we refine the idea.

Our goal is to provide comprehensive SRH services to youth in the setting where adolescent don't know their SRH rights and there are community norm and culture which denies their right. The adolescent told us, they start sex very early from 14 years and lack skills to make appropriate choices to prevent them from getting pregnant and their parents are not communicating freely about sexual issues to them . Most of them get married at 16 if they complete primary education without getting pregnant. Sometimes it is their parents who arrange for early marriage to get dowry. So many people influence their mindset and we will identify them and develop appropriate dialogue with them to support adolescent reach their goals.

Pathfinder is implementing the integrated approach known as Population Health and Environment (PHE) in the region. The program aims to sustain the natural resources along Togwe forest reserve area ( where camp is located) and improve health and well being of the population. We promote use of family planning for health timing spacing pregnancy and household to have small family size they can manage and reduce destruction of natural resources for food security. We work with the community to develop alternative livelihood means to reduce pressure in the environment. We will integrate educate the adolescents on links between family planning and natural resource management and promote them to practice positive health and environment behaviors.

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