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My name is Saredo Hassan, I am the Executive Director and Founder of Somali Gender Justice prevoiusly Somali Family Health service org (SFHSO) based in Somalia. I received my Bachelor’s degree in Psychology from Aden, Yemen and a nursing diploma from Bosaso, Somalia. I have three lovely children for whom my only wish is they grow up healthy and to contribute positively to their community.
*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.
@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.