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Engaging Men as Family Planning Health Promoters

Activating male community health workers to promote family planning and reproductive health among men in Somali communities.

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

Men decide, legally and culturally, about FP use (or “birth spacing”). Men are conservative about FP use and are sceptical of authorities who are pro-birth spacing. Men are socialized to hold conservative attitudes towards FP in order to maintain social status. Men receive the following messages about family planning: 1) In your clan, the larger your family, the better you are viewed 2) Men should be the decision-makers / leaders in their households Perhaps as a result, men are uninformed about the benefits of FP, including benefits to the marriage and to their wives’ health in general.

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

How effective can male Community Health Workers (CHWs) and Male Health Promoters (MHPs) be in this context to increase FP use? What resistance will men face by other men? How will this impact their ability to make a difference? Does this approach empower women to access FP services and make informed choices about their fertility?

Explain Your Idea

We will recruit a team of 20 male FP champions - recruited through the central MOH and regional health office in Gardo - based at 20 health facilities, urban and rural, across the Karkaar region in Puntland. Men will be recruited on the basis of their previous experience in engaging communities for social transformation, and their support for women’s empowerment. The 20 champions will be assigned to lead periodic community events, such as fathers’ group meetings and meetings with clan elders and religious leaders where they will educate and create awareness among men about the benefits of family planning. The 20 "male health promoters" will be trained for one week at the beginning of the pilot project, and then again mid-way through the year to identify challenges in implementation and discuss solutions. Training and monitoring materials will be developed drawing on existing resources available through Promundo, Save the Children and UN Women. Champions will be paid, as motivation will be important to keep promoters happy and effective. To complement this work, we will hire local artists and communication experts to develop tailored messaging to promote family planning use through billboards and radio messages on channels popular among male audiences. We are currently collaborating with Save the Children on focus groups and in-depth interviews designed to understand the service- and demand-side barriers to family planning use among young women.

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

• Encourage communication between couples on fertility. • Improve uptake of FP services among women / meet unmet met need of FP among women in Puntland • Improve community support and awareness of FP services, including from male-led religious and clan leaders.

How is your idea unique?

We have noticed through our work with female health promoters that men see family planning as women’s issues so we anticipate that hiring male health promoters will cast that family planning should be a men’s issue too. Unique from other programs, this idea relies heavily on staff training of the male champions. The radio and print messaging will ensure that men are receiving positive messages about family planning from different angles, a best practice in engaging men in reproductive health. Lastly an important part of the programme is reaching out especially to traditional male authorities like clan leaders and imams who can send messages about family planning to their constituencies. Currently there are no other male involvement health programmes or family planning in Puntland. Programs like this one are rare in the Muslim world and a successful pilot could lead to similar pilots in other conservative Muslim contexts.

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

• Male outreach may be ineffective in improving family planning use. • It is the first such program in Puntland and (we think) that this is an untested approach • Recruiting qualified and progressive men especially in rural areas may be a challenge. Questions is:- How to maintain funding for the next year 2019 and beyond to ensure the program remains intact after IDEO’s support runs out, lessons learned from implementation could inform a slimmed-down version of this program in future yea

Who are your end users?

We expect women of reproductive age and especially young women to be the primary end service user of this program. They will benefit through increased male support for their health and well-being. With 20 male staff, we anticipate being able to reach approximately 15,000 male community members annually with discussions centered on family planning. In addition, radio messaging and public billboards could potentially reach the entire Karkaar Region of approximately 200,000 people. Similar programs saw improvements in family planning use and increases in communication between couples. we expect men to benefit, as this will encourage happier relationships with their wives.

Where will your idea be implemented?

  • Somalia

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

  • Armed conflict
  • Prolonged displacement
  • Extreme drought

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

Somalia is listed in the State of the World’s Mothers Report (2015) as “the worst place to be a mother.” 1 in 12 women die in childbirth (UNFPA) and women face a lifetime risk of 1 in 18 of dying due to maternal causes. 35% of women have unmet need for modern family planning. Moreover, Somalia is currently experiencing a severe drought; 130,000 live in IDP camps across Puntland, of which the majority are women & girls. In these situations, women face significant health and safety risks.

What is your organization's name?

Somali Family Health Services Organization is a local non-profit organization whose main focus is improving reproductive and maternal health.

Tell us more about you.

My name is Saredo, I am a co-founder of SHFSO. I received my Bachelor’s degree in Psychology from Sanaa, Yemen and a nursing diploma from Bosaso, Puntland, Somalia. I have three children and live in Gardo. We are in good position to implement since we have a dynamic team who is capable, including: Jamal Mohamed Warseme, co-founder, who holds a MSc in SRHR in from Dalarna University in Sweden and is an advisor to the MOH. Abdikani Hirsi Shire, who is a registered nurse from University of Bososo and has years of experience with INGOs on maternal and child health Christopher Hook, advisor, who holds a MSPH in Population, Family & Reproductive Health from Johns Hopkins SPH and has worked in international SRH since 2011.

Organizational Characteristics

  • Women-led organization
  • Youth-led organization
  • Locally/community-led 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

The organization is headquartered in Puntland's capical city of Garowe with a sub-office in Gardo.

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.

How has your idea changed based on feedback?

We went to the community to solicit feedback. In general, community members were both fascinated & skeptical of the idea that men could be champions for FP. Men told us it would be very important to support the men we choose as promoers, as the cultural norms of the country run counter to men being involved in FP. This made us strengthen our training package, as well as M&E component to provide more monitoring and one-on-one counseling with the male health promoters, especially at the beginning. We also did a costing exercise. We realized that to be effective we should reduce the number of proposed champions from 40 to 20, at least in the first year. We also talked through our evaluation plan from feedback received through IDEO. For tracking FP uptake, we will be able to track referrals to FP services through trained clinical service providers at our health facilities. Last, we discussed sustainability. We think can sustain through partnering with MOH and leveraging funding.

Who will implement this idea?

Currently, our organization has four staff with deep clinical and/or programmatic experience in reproductive health and community engagement. If awarded, one of the Somali-based staff will be full-time, two will be part-time, and the US-based advisor will provide ad-hoc support. It is our hope to leverage the Amplify award to bring in other funding that will allow us to hire more staff. This idea does not work unless we maintain a close partnership with the MOH. We will work together to seek final approval on program design, develop our messages, train staff, measure our success, and disseminate results. We will also engage with the web of Puntland-based RH actors through "Reproductive Health Working Group" meetings, held quarterly.

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?

This organization was founded to support vulnerable women in Somalia facing unsafe pregnancy or spontaneous abortion. As such, the main driver of SFHSO is the passion for our mission. Part of this mission is making sure that we, as team members, cooperate and treat each other with respect. Big decisions are made through team dialogue, both remotely and in-person, that emphasizes creative solutions and respects input from all people. Typically, we would ask for two people to take on a discrete responsibility, such as applying for this Amplify grant. These two people would bring in the others as necessary to ensure decisions are made "as one." When we disagree, we seek to understand the root of the conflict and try to incorporate as much as possible the person's concerns into the decision.

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?

(1) The biggest day-to-day challenge for our end users is resource constraints. For Somali women, especially those internally displaced, basic supplies of food and water are threatened. This makes accessing healthcare sometimes a luxury, as women make the impossible decision to spend what little money they have on nourishment over health. The on-going drought, the most devastating in recent memory, adds insult to injury as families are forced to migrate to find water and arable land. (2) Somalia is deeply gender inequitable. Women don't have equal access to education, health care, or employment & are forced to depend on men to make decisions for them. What's more, there are few women in Somali government to advocate for the basic rights that women in other countries take for granted.

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?

IMPACT: By 2023, we aim for our male health promoters to bring positive reproductive health messages to 50% of the adult male population in Puntland, through both one-on-one and group counseling, and mass media messages done through radio and other commercial channels. QUESTION: Given adequate training and counseling, can Somali male health promoters act as effective vehicles for FP promotion, and will our program be able to overcome the sociocultural barriers needed to realize our vision.

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

First, we have been excited to engage in a process that has been educative for our team from a design perspective. We really enjoyed the storyboard tool! Second, we have enjoyed the process of developing our program and receiving on-going feedback from technical experts. Third, we appreciate the opportunity to apply for funding in this unique way that is encouraging of our creativity, and even fun at times! Our team's collaboration has been stress-free and very enjoyable from the beginning.

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?

  • 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:

  • Under $50,000 USD

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

  • Communications/Marketing/Graphic Design


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