Adolescent Reproductive Health Project

Phase I - August, 2000 - December, 2003;
Phase II - January 2004 - December 2006

The health status of Ethiopia is poor even compared to other sub-Sahara African countries. Life expectancy is estimated to 54 years. Only 51.8% of the population has adequate access to health facilities and it is estimated that there is one doctor per 28,339 people. The reproductive health statistics paint an even more daunting picture. The Ministry of Health reports that 75% of people marry before the age of 18 years. Ninety percent of pregnant women do not have a trained attendant during delivery, resulting in a very high maternal mortality rate of 871/100,000 per live births. In addition only 34% of pregnant women receive any kind of anti-natal care from health professionals. Most of these pregnant women are young girls. A recent national demographic and health survey found that one in six women aged 15-19 years already had their first child and one fifth of this population is sexually active. Ninety percent of these young women have undergone female genital mutilation. The rate of contraceptives use is only 17% nationally. Adding to this picture is the grueling reality of HIV/AIDS, with Ethiopia now ranked number three in the world in infection rates, totaling an estimated 2.6 million people who are infected with the virus. The current estimate of HIV/AIDS infection in the age group of 15-49 is 6.6%.

Baseline knowledge, attitude, practice and behavior (KAPB) surveys conducted in Northern and Western Shoa in 2001-2002 show that while knowledge of family planning ranges from 13% to 67% among rural and urban population groups respectively, contraceptive use is much lower, ranging from 19% - 27%. Rural respondents stated that more than 63% need to walk two to three hours to access contraceptives. Traditional behaviors such as early marriage, rape, abduction, and female genital mutilation are widely practiced in semi-urban and rural communities. Although 89% of the respondents have heard about HIV/AIDS, more than half of them do not believe they are at risk of becoming infected.

The David & Lucile Packard Foundation began a partnership with Pact to support a youth-focused reproductive health project in Ethiopia through two different grants to increase the reach of local NGOs with effective and expanded reproductive health services to Ethiopian youth.

Pact's approach

The Packard Foundation gave Pact two different grants, one to address each of the following issues:

• a grants program to support local and community-based organizations/ NGOs to implement basic reproductive health services for youth
• a capacity-building program funded by the Organizational Effectiveness Program of the Packard Foundation for the fourteen NGOs selected to implement the program.

Results - Phase I

Pact provided grants to 13 NGOs implementing adolescent reproductive health activities and provided institutional and technical capacity building support to these local NGOs and one community-based organization (CBO). Because Pact had worked with NGOs across all sectors in Ethiopia since 1996, partners were identified from a wide variety of development NGOs. The project successfully improved the capacities of these organizations, as demonstrated by the comparison between the base line organizational capacity assessments (OCAs) and the re-OCAs conducted one year later, which clearly showed progress and documented the positive changes in capacities.

The activity grants provided to NGOs to implement adolescent reproductive projects in 13 locations in Northern and Western Shoa and Wollo Zones achieved significant results in positively influencing attitudes and behaviors of adolescents and youth to protect themselves from reproductive health problems and play advocacy roles. The activities also encouraged parents, school communities, and local governments to collaborate in the prevention and reduction on the impacts of reproductive health problems. A few specific results include:

• Through the grants program Pact's partners reached and influenced 69,296 females and 74,996 adolescents and youth by training and empowered 275 female and 332 male peer leaders/educators.
• In total, services, including contraceptive distribution through community-based programs and referrals to public health services, involved distribution of 31,540 cycles of pills, 390,267 condoms, and 5012 vials of injectables in the different geographic locations.
• Ethiopian NGOs organized and empowered reproductive health clubs that implemented innovative and replicable youth-focused projects reaching 148,079 female and 189,362 male adolescents and youth between the ages of 10 and 24. In addition over 350,000 community members were reached through mass information, education and communication (IEC) efforts by the clubs.
• Exposure visits to learn from best practices in the area of youth and reproductive health helped to disseminate effective program ideas and facilitated the replication of the best practices.

Phase II - January 2004 - January 2006

Given the results of Phase I and the still significant needs the country faces in adolescent and reproductive health, Pact proposed to scale up and strengthen existing interventions and to significantly integrate a sustainability component to its activities. Adolescent-focused interventions were initiated during the first two years of the project, but behavior change approaches, which represent a longer-term process, were not. In addition, most reproductive health (RH) interventions have been implemented in largely in urban and semi-urban areas, while the majority of the young populations reside in the countryside and have extremely limited access to health and reproductive health information and services. One of the opportunities to build on and scale up the experience under Phase I lay in the experience of the 14 NGOs with which Pact has partnered. These NGOs were well placed to expand their interventions and coverage into more rural areas, building on the strengths of their adolescent RH interventions and their positive working relationships with stakeholders, including local governments, community leaders, parents, schools, other NGOs and the community members/clients themselves.

Pact's approach

Building on results to date through two additional grants from the Packard Foundation for subgrants to local NGOs and for capacity building activities, Pact will:

• Develop a competitive grants program
• Work closely with partner ARH NGOs on continuing existing interventions through supporting ARH clubs in becoming self sustaining. A contractual mechanism will be arranged to allow NGO-NGO transfer of skills in maintaining and sustaining community-led income generating grain banks that can throw off income to support RH activities.
• Provide grants to expand the scope and reach of five youth associations in order to scale up activities in rural areas.
• Provide three grants to organizations in new regions into which the Packard Foundation seeks to expand.
• Provide one service contract to Bizsoft/DRC (Pact's Development Resource Centreand Bizsoft is an existing IT company) to provide education, awareness, training and promotional materials on RH.
• Provide capacity building services to assist local NGOs in developing the infrastructure and putting systems in place that will allow them to scale up and expand their outreach.

Interim results

• Assessment visits made to ten ARH and arts clubs and associations established and strengthened during Phase I in the Northern and Western Shoa zones of the Amhara an Oromia regions. Out of these ten clubs, six have been officially registered with the government as ARH associations at the zonal level while one is registered as an advanced club at the Woreda level. The other three are advanced RH clubs and are in the process of registering as associations.
• Developed and implemented a competitive process to provide funding for scaling up innovative ARH projects. To facilitate this process Pact developed and distributed a standardized proposal development format to 13 partner NGOs. Thirteen proposals were submitted and reviewed by the proposal review committee. Funds were dispersed to all 13 NGOs and youth associations. The total grant value was US$356,200.
• Conducted training on "Survival is the First Freedom" - to provide skills on the use of a collection of tools for applying democracy and governance principles to HIV/AIDs work.
• Gender mentoring that includes gender analysis and program development is on-going for seven partner NGOs. The mentoring process will soon be completed by producing a gender integration and consideration document in each organization.
• The organizational capacity assessment (OCA) was conducted with five anti-AIDS and reproductive health associations. Training was conducted for strategic planning and management teams in each organization and mentors assigned to each organization. Currently all are in the process of developing a three-year strategic plan and management document.
• A number of grain banks and other income-generating (IGAs) activities have been established to foster the sustainability of reproductive health projects in the program areas by providing income for the RH clubs and associations. Such projects include, but are not limited to: renting mules (tourist projects), vegetable gardening in Tullu Bollo, tea and coffee sales in two project sites, petty trade, and sheep rearing.
• Nineteen youth clubs have been strengthened to provide RH services, an increase from the target of 15, due to the demand from rural Kebeles. Activity implementations by the partners have successfully reached over 34,000 male and female adolescents and youth in urban and rural areas.
• The NGOs and the associations receiving sub-grants have accomplished many planned activities. Activities include: organizing youth clubs, training of peer educators, mass and peer education, parent-to-parent and parent-to-youth discussion, referral of youth to health facilities for services like family planning, treatment of sexually transmitted infections, and counseling.