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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.

Photo of Sareda Hassan

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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

18 comments

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Photo of Grace Cai
Team

Engaging men is definitely a great first step to better educate the overall society on family planning. I was wondering if there are ways for the program to also promote dialogue between parents and children on reproductive health?

Spam
Photo of Quran Host
Team

It is a general phenomenon that children are better in memorizing than the adults. They learn fast and they adopt new things earlier as the adults could do. This is why it is the better opportunity that the parents get their young children enrolled in the online Quran classes so that they are able to learn fast and better. Children who are about five years old are the best to get admission in these classes. The best time to learn anything is to learn at a younger age because this is the time when the teachings remain on the child’s mind for the lifetime. The lessons of Islam provide us happiness, guidance along with the sense of clarity and fulfilment and they also help us to be on the right path, the path of truth and virtue where you can confidently feel that whatever you are doing would please Allah Almighty. https://www.quranhost.com/

Spam
Photo of Chelsea Takamine
Team

Congratulations Sareda Hassan and team - welcome to the Amplify portfolio! Check out this winners blog post featuring your idea: https://challenges.openideo.com/blog/amplify-reproductive-health-challenge-winners-announced

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Photo of Sareda Hassan
Team

Thank you Chelse and amplify team for seleting our idea,We are so great full.

Spam
Photo of NAC Norwegian Afghanistan Committee
Team

Dear Sareda,
Just wanted to applaud your approach: engaging men in these issues are key for fostering change and understanding and this is crucial in the contexts where we both work!

Spam
Photo of Ahmed Mahamed
Team

Wonderful, i liked this ideas one stop forward, for sure it will reduce maternal mortality in our community.
Male involvement is number one priority in our currant situation, keep the momentum team.
Wish you all the best and am curious to see that ideas implemented.

Spam
Photo of Zaytun Abshir
Team

Women are among most vulnerable groups in our society and Somali accounted worst place to be mother reasoned by one of every 18 pregnant women dies.
this contributed by lack of decision for women, long list activities in the home, lack of male involvement in the on going health program .  
getting this ideas will have a great impact on women's wellbeing, I do believe that there will be certain challenges you need to overcome to realize your ideas implemented as it is first time to carry like this ideas.
thanks you so much for taking up this and good luck with your valuable ideas.

Spam
Photo of Jama Mohamed
Team

It is good idea to prioritize male involvement because social norms in Somalia regard birth spacing as women's issue, while men are required to earn family subsistence. Such stereotype has to challenges and reversed.
By 2017, over two decades of internal conflict and famine and a collapsed health sector had left 80% of Somalia’s population without access to basic health services. The prospect of giving birth in the presence of a trained midwife or of accessing family planning – or “birth spacing” – services is still a distant dream for the vast majority of Somali women, and one in 14 pregnancies ended with the mother dying. Somalia still has a long way to go to offer all Somalis who want them access to birth spacing services, the presence of midwives at childbirth, and antenatal and postnatal care. Spousal communication can improve family planning use and continuation. Yet, in Somalia with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods.
Sensitizing men about family planning and training them about their roles when it comes to family planning. They will come to know the importance of family planning to the mothers, babies and families , as now most then have limited idea about the issue.
Reproductive health decision-making is the shared responsibility of men and women. Growing evidence suggests that involving men in family planning can increase women’s contraceptive uptake. Yet, in many sub-Saharan African settings, few men are involved in issues relating to reproductive health. At the same time, men’s lack of involvement was blamed on current health services delivery, including awareness-raising campaigns, which have traditionally targeted to women. This was thought to further define family planning as a woman’s domain, including initiating partner discussions and managing contraception. In Somalia where male involvement was perceived appropriate, lack of knowledge about how to be involved men was often the issue  or it is not been prioritized.

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Photo of Mohamed Sujuur
Team

Mother's well-being is one of the most important element that a family has to have. And without it I think not only a family will suffer but it will definitly have a negative impact in society .
Family planning for me is not a newly invented concept. It's actually encouraged in Quran that the mother must breast feed their newly born babies upto 2 yrs . Its true that alot of men in somalia do not give the the importance it deserves to help mothers to take sometime in between as they prefer to have children in quick succession which in alot of cases have a negative consequences.
I am not against of having many kids but I think mother's wellbeing should be prioritised. It's is not a man problem only, female have to role to play to change this in a positive way.
Thanks

Spam
Photo of Jamal Mohamed
Team

having such a unique ideas will be great for Somali women to access for better health, break barriers, and survive from the death.
Thanks guys for thinking widely and women is only hope that Somali nation have and they will thanking you for caring them.
#men shall involve the health promotion.

Spam
Photo of OpenIDEO
Team

Hi @Sareda Hassan @Sareda Hassan 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 of this idea is also the growth of area of this idea. Engaging men in SRHR is critically important and by doing so in a conservative/religious environment this idea has the opportunity to make a real difference.
*The idea to focus on men is really interesting, and an important one to test.
*We’d love to learn more about the recruitment and training of the male champions. How will you select them, will they be paid, what will the quality of training be, and how will it be delivered?
*Since they are conducting FGD and interviews with women and men on family planning, this will contribute to their understanding of how to incorporate context specific considerations in their approach. And they will gain local insights and target users.
*This idea gets to the heart of one of the key known barriers to family planning uptake in this region. It would be interesting to understand how you will manage some of the risks in this approach such as male champions maintaining conservative views and not delivering the desired messages, or that the male champions will not be listened to or get access to the people for whom it will make a difference.
*It would be interesting to know if wider SRH will be included: will the male champions be trained to discuss more than family planning?
*Why is this intervention important in this particular humanitarian setting?
*Engaging men in family planning uptake is critical, as well as ensuring the availability of services and commodities on the supply side.
*How will you measure family planning uptake / attribution to your intervention?
*Have you considered plans for long term sustainability?

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
Photo of Sareda Hassan
Team

@openideo, thank you for your comments. We felt they were insightful and really made us think through our program in a deeper way. Full answers are below - and have made sure the important pieces are in the full body as well. Mahadsanid!

RESPONSE PAGE 1:

*We’d love to learn more about the recruitment and training of the male champions. How will you select them, will they be paid, what will the quality of training be, and how will it be delivered?

We will select our male champions through the central MOH and regional health office in Gardo. Criteria for selection are graduation from high school, experience engaging community in social transformation, good communication skills, good public speaking skills, supportive of women’s empowerment & reproductive health, and excited to talk to men about behavior change for community transformation. They will be paid. $100/MHP/month at PHU, $150/CHW/month at HF. Based on past experiences, we know that motivation will be important, so this pay is slightly higher than for others doing similar work. The training materials will be developed within the NGO technical team including US advisor, and vetted with MOH. Training materials will be culled from existing evidence-based training documents used in other countries from organizations like Save the Children, Promundo and UN Women. We anticipate holding one initial week-long training and then again a 2-3 day training after six months to refresh and discuss experience so far. It will be delivered by a national or East African consultant with experience providing training in gender equality and reproductive health. We will monitor learning with simple pre- and post-tests delivered at the beginning and end of both trainings.

*This idea gets to the heart of one of the key known barriers to family planning uptake in this region. It would be interesting to understand how you will manage some of the risks in this approach such as male champions maintaining conservative views and not delivering the desired messages, or that the male champions will not be listened to or get access to the people for whom it will make a difference.

A lot of it comes down to HOW the message is delivered. Rather than a didactic approach, we intend to empower our male champions to use innovative, interactive teaching methods, including using dramas, having community listening sessions of Somali traditional music (thanto), and playing games. In general, we want each male champion to come up with his own approach that he believes will work best in the community where he lives.

Another important piece is the quality of the training and support from monitors, which we intend to be robust. For the training we will will draw on evidence-based literature from Promundo, Save the Children & the UN on how to change hearts and minds related to gender equality. Last, we think it is important to manage our expectations. When the first family planning service provision and promotion project came to Karkaar in 2012, it was such a sensitive topic that the initial pilot was called “BeMONC.” Slowly, norms are changing around family planning use, but it does take time. We do not expect to realize social transformation around reproductive health at once. However we are confident that by directly engaging men through male champions – an approach not tried in this region, to the best of our knowledge – we think we can fill an important gap that will lead to social transformation in years to come.
*It would be interesting to know if wider SRH will be included: will the male champions be trained to discuss more than family planning?
We will train them on SRH in general, with family planning as a focus, and with gender equality/support for women as the framework for these discussions. We will also discuss with them ways to improve couples communication about health issues (see Male Motivator program: https://www.k4health.org/toolkits/igwg-gender/male-motivator-training-curriculum-using-male-motivators-increase-family). We do believe it will be important to let our trained staff have some creativity in message content and how they deliver these messages.

Spam
Photo of Sareda Hassan
Team

@openideo

RESPONSE PAGE 2

*Why is this intervention important in this particular humanitarian setting?
Somalia was 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 report) 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 in the midst of a severe drought, and 130,000 live in IDP camps across Puntland, of which the majority are women & girls. In such settings, women face risks of sexual violence, poor menstrual hygiene management, unintended pregnancy, and unsafe abortion and births.

*How will you measure family planning uptake / attribution to your intervention?
We will be able to track referrals to FP services through trained clinical service providers at our health facilities. A referral is defined as “a client or representative of a client, such as his wife, referred to FP services by a male health promoter and who successfully receives services.” As a rule, providers already ask each client during counseling: “were you referred here? Who referred you?” While we won’t have the resources to directly measure the %mCPR in our population before/after intervention, we feel that this way is a low-cost means to measure uptake. We look forward to any feedback from IDEO’s technical team as to ways to improve our proposal.

*Have you considered plans for long term sustainability?

One important factor will be a partnership with the MOH. We will work together, as partners, to develop our messages, train staff, measure our success, and disseminate results.

Another is cost. We believe that it will be important to pay our staff well, as motivation is often a key factor missing in such programs. This is a risk, of course, because as of now we cannot guarantee funding to our staff past Year 1. However, during Year 1 our staff will work hard to leverage Amplify funding with local and international fundraising efforts. The most promising connection seems to be our staff’s connections in the region with Save the Children. We sincerely believe that we can tie this effort in with Save the Children’s existing “FP-PAC” program in future years.

Last, building capacity with staff will take time, and norm transformation around reproductive health and gender equality will take even longer. Partnering with key male-led institutions such as clans, and mosques (imams) can help us ensure the change is disseminated through appropriate channels. Fortunately, there is existing work within the Somali government and imam networks to institutionalize gender equality. Somalia’s 2017-2019 National Development plan (http://mopic.gov.so/wp-content/uploads/2016/11/National-Development-Plan-2017-2019.pdf) states that the government intends to “implement gender equality in education and mainstream gender in all of its programs.” Further, the recent adoption/translation of the sentinel text “Family Planning in the Legacy of Islam” by national government/religious leaders (and creation of BCC messages around it) suggest an increasing focus on these issues and presents an opportunity for our program.

Spam
Photo of sadiya Mo
Team

This is a great idea, and I would love to see it implemented. There is a great need to expand the role and the view of fatherhood beyond the culture norms of being a head of the household. They should take an active role of promoting women's wellbeing, preventing child poverty and being part of decision making from the beginning to the end.

I have wittiness the suffering of both Somali women and children due to the lack family planning service along with poverty. With a good education programs like this, to tackle the stigma and genders inequalities, we could all prosper as a society. Its the time to move on from STONE AGES to 21st century. Good luck and wish you all the best.

Spam
Photo of OpenIDEO
Team

Hi Sareda Hassan and team!

An important reminder, Refinement Phase closes this Thursday, October 26 at 11:30pm PST.

We can only consider complete submissions, so please make sure that you have reviewed the Feedback and Refinement Phase Checklists and answered all of the questions on the platform. Note that we added one more multiple choice question to the end of the form.

If you're having trouble figuring out how to edit your idea, please refer to this guidance: https://docs.google.com/document/u/1/d/e/2PACX-1vQUuV2N-wO8Oy8MysMAza3CbKUA1ZcMenollZjPh4FA0fGgIDcVXwWtEe6CLh36_Wik5AypEHixreFH/pub

Best of luck!

Spam
Photo of Christopher Hook
Team

Love this idea of engaging men! Unique among the other ideas.

Spam
Photo of Sareda Hassan
Team

Yes, we feel men are an untapped resource for improving reproductive health outcomes. The principal institutions of Somalia: Islam, government, clans - these are all dominated by men and so if we can enlist them to promote family planning, then we feel we can make a big change. Thank you for your comment!