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Comprehensive Community-Based Prevention and Response Support Program on Sexual and Reproductive Health (SRH) Rights in Nepal.

Using strength-based expressive methods to sensitize, engage and create resilience among communities affected by natural disasters in Nepal.

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

Natural disasters have immediate and long-term devastating health and psycho-social effects on individuals, families and communities – including disruption of community-based traditional support structures; trauma; increased Sexual and Gender-Based Violence; limited access to sexual and reproductive health knowledge and services; and negative coping mechanisms resulting in unwanted pregnancies, unsafe abortions, sexually transmitted infections, and high-risk childbirths. In time of crisis, service providers and infrastructures are considerably weakened further increasing the vulnerability of affected populations. The lack of health infrastructures at peripheral level , including SRH services, make the situation even more precarious.

What are some of your unanswered questions about the problem(s) you are working to address?

 How to effectively integrate and mainstream SHR and Psycho-social goals and activities into comprehensive and quality services that reflect the needs of the affected communities?  How to ensure long-term consistency and commitment of service providers - as well as trust of communities?  How to effectively collect, systemize, analyze and confidentially share relevant data to impulse change in practice and advocacy?  How to involve security sectors in the above 2 sectors of activities?

Explain Your Idea

IsraAID Nepal seeks to implement an integrated 18-month project to create a sustainable psychosocial and SRH support infrastructure through combining performing arts and capacity building for Female Community Health Volunteers (FCHVs) in 6 affected districts. The objectives are to 1) raise awareness and understanding of key SRH rights and explain how trends such as SGBV negatively affect individuals, families, communities and society; 2) actively engage communities to promote resilience, and 3) strengthen the capacity of female community health workers to provide timely and quality SRH services. The project will be implemented through national partners to build on existing health structures and resources. There will be an initial holistic training phase for FCHV’s, teachers, and members of the Theater Group on SRH including community-based referral mechanisms. Then, the Theater group will engage with beneficiaries in communities and schools allowing for strength-based expressive methods of communicating important messages. The Theater Group will create awareness on topics relevant to building trust and reducing stigma around SRH services, as well as helping to identify those in need of such services. Drama and performing of creative arts provides the most appropriate and culturally-tailored tool and entry-point for communities affected by and/or vulnerable to natural disasters for increasing awareness about SRH-related issues.

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

1. It will create awareness, knowledge and understanding of SRH rights and services as well as encourage community engagement and resilience through strength-based expressive methods (arts and drama); 2. It will enhance the capacity of community health workers – especially female service providers to provide quality, timely and trusted SRH knowledge and services; 3. It will create rapport between health service providers and communities through participative drama – thus enhancing trust in and access to services.

How is your idea unique?

The model integrates both Psychosocial and SRH needs and services into a holistic approach. It utilizes traditional non-verbal methods (i.e. strength-based expressive methods) to enhance knowledge, encourage community engagement and trigger resilience, in a way that is fully integrated into the existing Nepali culture. It allows for communication, encouraging personal and community connections on non-verbal levels. It provides an opportunity for creative, sustainable, and integrated problem-solving approach related to SHR (e.g. against stigmatization). It encompasses 4 intertwined components of comprehensive prevention and response services: 1) capacity of health workers (response); 2) knowledge and understanding of SRH (with integrated PSS) in communities (prevention); 3) trust in and access to services and 4) resilience. Those 4 pillars are fundamental to ensure effective crisis preparedness and response communities affected by conflict, natural disasters, displacement and distress.

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

1.Stigma around family planning – especially abortion (thus the importance of using strength-based expressive methods and community engagement); 2. Since most community activities are outdoor, specific considerations will address weather-related challenges and logistics concerns; 3.Relationship with security actors may be tense, thus the need to build trust; 4.Abuse in the home is difficult to combat. We will include members of society to support and guide the family to ensure children’ safety.

Who are your end users?

Direct Beneficiaries: - 8,000 people will directly benefit from community workshops in 400 district committees - with a focus on adolescent girls (age 12-18); - 12 health specialists will benefit from SRH Training of Trainers (ToT) sessions; - 30 Teachers will be trained on referral pathways and symptom recognition for facilitating collaboration between FCHV’s, families, and children; - 30 District Level Performers (DLPs) will benefit from intensive training in performing arts skills and basic SRH training from the health specialist’s teams; - FCHV in 400 districts will benefit from training; - Members of the VDCs women’s groups. Indirect Beneficiaries: - Total population of the 400 district committees (strong multiplier effect)

Where will your idea be implemented?

  • Nepal
  • Sierra Leone

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

  • Natural disaster
  • Community at risk of disaster

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

Nepal is prone to natural disasters including landslides, earthquakes, and floods which claim many human lives and cause other physical and psychological damage every year. After the earthquake, families of six or seven are forced to this day to live in confined quarters without privacy privacy or security for vulnerable members. The present model can be adjusted to other countries affected by disasters, and displacement where IsraAID is present, such as Sierra Leone.

What is your organization's name?

IsraAID (Nepal)

Tell us more about you.

IsraAID is an apolitical INGO providing humanitarian and development assistance to populations affected by conflict, displacement, acute poverty and natural disasters in 20 countries worldwide. In emergency settings, IsraAID provides direct assistance to populations in needs in full cooperation with national partners. In post-disaster contexts, IsraAID’s mandate is to accompany national partners in their efforts to design, implement, deliver, monitor and evaluate sustainable projects, programs and services of quality that meet the long-term protection, health and education needs of communities affected by crisis and displacement. IsraAID places a particular emphasis on sustainability, inclusiveness, gender sensitivity and local ownership.

Organizational Characteristics

  • International/global organization

What is the current scale of your proposed innovation?

  • Global - within more than 1 geographic region globally

Experience in Implementation Country(ies)

  • Yes, for more than one year.

Expertise in Sector

  • Yes, for more than a year.

Organization Location

Headquarters are in Israel but we have registered offices in 14 countries worldwide - including Nepal and Sierra Leone.

What is your organizational status?

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

What is the maturity of your innovation?

  • Existing Prototype or Pilot: Tested a part of my solution with users and am iterating.

Website

http://www.israaid.co.il/ https://www.facebook.com/israaid/

How has your idea changed based on feedback?

IsraAID's team in Nepal conducted gender-sensitive Focus-Group Discussions (FGD) with teachers, pupils, partners, service providers and staff. The discussions highlighted the importance of training and involving teachers who could, if/when the children and youth wanted, be approached for information and/or referrals to FCHV and other services. It gives additional choices to children and youth - in full respect of the survivor-/client-centered approach. The FGD also shed light on the need to focus, primarily, on children and youth boys and girls through school-based interventions in order to bolster positive behavioral changes from an early age. Regular and consistent theater performances will therefore be conducted in schools, and expended to communities to include parents and families.

Who will implement this idea?

We already employ a full theater group, have a well-entrenched network of counselors and FCHVs in every district, and have solid connections with local governance structures. This allows us to effectively conduct our activities, together with our local NGO partners. IsraAID will provide technical oversight, guidance, and training, while our theater groups and local partners will be directly interacting and working with beneficiaries and service providers. The theater group members will work full-time, while the FCHVs are volunteers embedded within the community who respond to needs as they arise. Service providers work within existing service infrastructures (e.g. health facilities) - such ensuring sustainability and local ownership.

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?

IsraAID embraces of very flexible and participatory decision-making process – emphasizing full inclusion of beneficiaries and national partners. We currently have a Programs Manager and a MHPSS Manager who engage in conversations with the Country Director and relevant partners before any decision is made. When a shift is necessary, the decision is implemented after approval of the senior management in the country office. If highly technical changes are needed, IsraAID HQ is consulted to ensure respect of best practices. As a flexible, dynamic, innovative and community-oriented organization, IsraAID’s “bureaucratic burden” and administrative delays are very limited. IsraAID’s adaptable way of working allows for rapid and effective monitoring, review and readjustments when needed.

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?

In general, the younger generation in Nepal is dissuaded and deterred from voicing its opinions and concerns. Adults and prominent individuals hold an extremely elevated societal position, and this hierarchy typically silences and marginalizes young people's voice. This societal norm has contributed to Nepal's astonishingly high suicide rate - now the seventh highest in the world. This young population group has become increasingly vulnerable to exploitation, since shame and silence are typically the only responses to abuse. Depression, other mental health problems and teen pregnancy are now extremely prevalent issues amongst young people. Our program's activities show young people how to speak out and seek help, and that their voice is valuable, powerful and will be listened to.

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?

The project seeks to ensure that there exists solid and trusted community-based prevention and response mechanisms that ensure the rights, dignity and safety of all within Nepali society – especially of the most vulnerable groups. How to effectively scale-up this project nationally and internationally and target a broader number of beneficiaries, with time, within and outside Nepal – while ensuring sustainability, long-term local ownership and consistent multiplier effect over time.

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

We are particularly interested in exploring the human-centered design approach. This online funding mechanisms places particular emphasis on effective and practical tools to engage communities / beneficiaries - thus positioning them at the very center of needs assessment, planning, implementation and decision-making. Such approach ensures the sustainability and local ownership of projects beyond the specific intervention.

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

  • We aim to implement our Amplify idea in support of displaced populations, but not in a refugee camp / temporary settlement.

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

  • Between 1 and 2 years

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

  • Between 5-10 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 $100,000 and $500,000 USD

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

  • Program/Service Design

7 comments

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Spam
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Team

Hi Ophelie and Team -

We’re excited to share feedback and questions with you from a set of experts that are supporting this Challenge.

We encourage you to think about this feedback as you continue to improve your idea, whether that’s refining it 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, but all critical information should be in the body of your contribution somewhere.

* A strength is that you already have programs in place in Nepal that look to fight taboo and stigma. This will provide useful when building rapport with the community.
*An area of growth could be engaging the community and especially the women on content that they feel is stigmatized. Their needs and what they want to learn about is key to the success of this program.
*Have you considered challenges related to how to publicly address people on SRH needs? Getting the community leaders on board with this even during disasters is important. IsrAID seems to have an already robust program in Nepal. I would love to see this type of programming of tearing down stigma paired with a program that provides SRH services to the women.
*This idea seems new and bold to me. I see from the photos and video that this type of programming has already been implemented by IsrAID in Nepal. How do you plan to implement the program in a new community, like in Sierra Leone?
*It would be interesting to see if there was research on if the end users see this as important.
*The program both seems feasible with the connections that the organization already has in Nepal.

In case you missed it, check out this Storytelling Toolkit (ideo.to/OZznV4) for inspiration on crafting strong and compelling stories as well as the recorded Office Hour (ideo.to/Gf1Cs6). Storytelling is an incredibly useful tool to articulate an idea and make it come to life for those reading it. Don’t forget - the last day to make changes to your contribution on the OpenIDEO platform is October 26 at 11:30PM PST.

Have questions? Email us at amplify@ideo.org

We look forward to reading more, and thank you for the important work that you are doing!

Spam
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Team

*An area of growth could be engaging the community and especially the women on content that they feel is stigmatized. Their needs and what they want to learn about is key to the success of this program.

To further define the activities the theater group will conduct (performances, key messaging, community engagement, discussion groups etc.), we will work with counselors, teachers, women and youth groups in the community. They will help designing key messaging through discussion groups, ensuring the content of the theater is appropriate, culturally-relevant and engaging. In training the FCHV’s and teachers, we will keep in mind the input from the FGDs, the experience map and our previous best practices. Understanding the needs of both the parents and the children, in terms of societal pressures and how to deal with these sensitive issues, is extremely important and will be done through a series of informal FGDs hosted by our counselors currently in the field.

Accountability for Affected Populations: IsraAID ensures the strong and consistent involvement of beneficiaries and national partners in the decision-making process. Feedback and complaint mechanisms are included in each project and the whole organization. Participation mechanisms are in place throughout the project cycle to ensure inclusiveness, accountability and transparency. IsraAID places strong emphasis on accountability to affected individuals with disability, ensuring their full participation in the design, implementation, monitoring and evaluation of the project.

Gender-sensitivity: IsraAID’s approach fully reflects the specific needs of women, men, girls, boys, people with disability, the elderly, pregnant and lactating women, displaced/host communities and other vulnerable groups. Gender and vulnerability assessments are conducted for each project.

*Have you considered challenges related to how to publicly address people on SRH needs? Getting the community leaders on board with this even during disasters is important. IsrAID seems to have an already robust program in Nepal. I would love to see this type of programming of tearing down stigma paired with a program that provides SRH services to the women

The backbone of this program is to create a platform whereby we can openly dialogue on sensitive and stigmatized issues. Using theater as a mode of communication allows for the audience to relate to the characters, speak about the issues raised in a theoretical manner, and connect to the situation without the need to publicly speak about specific circumstances in which they find themselves. Especially for younger children who may not know how to approach this issue, the theater team will act out successful means of handling difficult situations, providing solutions through the script, and utilizing appropriate communication techniques. Before any performance is scheduled a process of speaking with community leaders and Headmasters of schools is embarked upon with our counselors and sensitized members of society who can help in their own words explain why such a project is necessary and beneficial for their community.

*It would be interesting to see if there was research on if the end users see this as important.

While our current programs utilizing theater and FCHV’s in the seven targeted districts do not focus specifically on SRHR, they do look at stigmatized mental health problems such as suicide and depression. Through this process, we have been able to identify almost 2,000 cases of individuals in immediate need of mental health support services, and have created dialogues around these difficult issues in schools and rural communities with great success. The children whom we have interviewed following the theater programs always speak about how interesting, informative and engaging the plays were and how they learned from this mechanism. This level of personal engagement with the material is exactly why we believe incorporating an SRH focus into this structure will be successful.
In the recently-held Focus Group Discussion which included counselors and FCHV’s, a case study came up showing this exact scenario. A young girl had been abused continuously by her uncle but had nowhere to turn for help. Our theater group came to her school, and she felt emboldened to speak with one of the female health volunteer. With the consent of the survivor, she put her in touch with one of the counselors, and together, identified a support plan.

*Application in Sierra Leone:

Role playing and story telling are important pillars of Sierra Leonean culture. Such components could be easily and effectively integrated into our existing GBV and women empowerment programs .

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