Thank you for these great questions! Please see our responses as follows:
Question 1 on the CHT and sustainability: Americares ensures sustainability through two strategies. First, health outreach in communities is already under the CHT mandate, and to date this has largely focused on child health interventions, such as immunizations. What we have done is expand services offered, such as distribution of vitamins and deworming tabs. Through this challenge, we hope to expand these services further to include family planning services. So we are building capacity within an already established mechanism.
Second, the Liberian Ministry of Health recently revised the community health policy to galvanize community-based services with a plan to deploy one Trained Community Health Assistant (CHA) to serve 350 people in remote communities. Currently, there are no trained CHAs in Grand Bassa County, but it is anticipated that they will be deployed in the future. Once CHAs are trained and deployed, this project will include CHAs in the outreach team so that they are coached and mentored to provide family planning services and education.
Question 2 on our target population: This project would target all people of reproductive age with family planning services and information, with a focus on adolescent girls. The education component of the outreach work aims to not only reach girls and women of reproductive age, but also bust myths about family planning for the entire community, including key influencers. In a formative assessment conducted by Americares in June 2017, intimate partners and peers were identified as some of the largest influences on girls’ and young women’s decision not to use family planning, along with myths and misconceptions about the safety of contraceptive methods. By educating the general community on the benefits of family planning, as well as providing fact-based information on the range of methods and their side effects and efficacy, the camps aim to increase the acceptability of family planning in addition to improving access in rural communities. Furthermore, any member of the community desiring family planning services will be encouraged to access these services, regardless of age or sex.
Question 3 on FP methods and training: Americares currently works with traditional midwives (TTMs) and general community health volunteers (gCHVs) each month to train them on a broad range of RMNCH topics, including family planning. Through family planning training, Americares’ community outreach officer, herself a registered nurse, educates TTMs and gCHVs about methods of family planning and their side effects and benefits. This enhances the ability of these health workers to educate and counsel the communities they work with on family planning, and refer patients to health facilities to receive further FP counseling and select a method. TTMs and gCHVs themselves will not be dispensing the contraceptive method as part of the FP outreach camps, as they are not trained health care workers. During the camps, TTMs and gCHVs will primarily be responsible for mobilizing communities to attend the health camps and supporting community education efforts.
This project will offer the full range of modern family planning methods. Americares will facilitate IUD and implant insertion trainings for facility-based health workers who are not trained to insert these LARC methods, and provide ongoing coaching and mentoring to build the confidence and skill of these health workers providing these methods. Girls and women who select an IUD as their preferred method will be referred to their nearest clinic for insertion, as in many communities it will not be possible to provide a clean, safe, and private setting for safe insertion. The outreach team facilitate transportation to the clinic for IUD insertion.
Question 4 on idea differentiation: This project will complement the important family planning awareness raising work and technical assistance to facilities that PPAL is doing in Grand Bassa County by bringing family planning services directly to isolated communities that cannot easily reach health facilities on a consistent basis. Recently PPAL also started doing outreach camps in two districts of Grand Bassa County, but they do not include the two districts where Americares is doing health camps, and are not on the recurring schedule that we propose to implement to ensure the ability to follow up with patients and provide continuity of method use for FP users. Americares consulted PPAL during a formative assessment for the design of this project, and remains engaged with PPAL and enthusiastic about opportunities to collaborate to strengthen reproductive health for young people in Grand Bassa County.
Our first project year accomplishments will include:
• Completion of a baseline for target behaviors. We will systematically select groups of boys and girls from different ethnic groups, and married/unmarried girls to participate in data collection activities (i.e., projective drawings, pile sorts, etc.) as well as brief focus groups. This will establish a baseline of experience and perceptions of local ASRH services and needs across the contexts of various ethnic groups.
• Further input gathered from each of our target groups will inform the communication and facilitation methods to be for used for our interventions.
• Baselines will be gathered from influencers of each target group such as parents and community leaders, as well as for the Health Post health workers and the female community health volunteers (FCHV). This information will further inform the content and approaches for activities designed for them.
• We expect to have developed facilitation guides for each intervention activity for the adolescents, and to have trained the facilitators from our partner NGO. Other activities will be underway, including the identification of the diversity of adolescents in each community, and the formation of the peer groups.
• ASRH orientation materials for a) health post workers and the FCHVs; b) community leaders; c) parents, will be drafted, field-tested and in use.
• By the end of year one, we will have identified some successful approaches to better address ASRH needs through utilizing similar data collection activities at strategic points across implementation phases. Our aim is to see improvements in ASRH knowledge and attitudes as well as increased interaction with trusted adults and service providers.
Please let me know if you have any other questions, thank you!