RMNH project in Afar Region

The RMNH project is a collaborative program that deals with eliminating demand-side barriers to the uptake of RMNH (reproductive, maternal and neonatal health) services in Afar region. As a competent and well-meaning public organization, Tiruzer Ethiopia for Africa (TEA) in partnership with Afar Development Association (AFDA) and Semera Health Sciences College (SHSC) is complementing the efforts of the government and play meaningful role by undertaking an integrated RMNH promotion program through three highly innovative implementation strategies that are believed to encourage behaviors that promote healthy and appropriate care-seeking behavior among pastoralist communities, and eradicate those practices that are harmful. The three innovative strategies come as a package and they are referred to as ‘SMS’.

The SMS package consists of social mobilization (S), money for women (M) and service quality promotion (S). They are described as follows.

Strategy #1: Social Mobilization:

When socio-cultural barriers are the dominant demand side problems to the uptake of RMNH services, it is quite logical to educate the entire community to alter its behavior and practices and adapt new and positive ones. Hence, that is why we adopt social mobilization as one strategy. The strategy uses community conversation (CC) as a tool and works through three groups of society – youth, women and community elders. Youth are organized in ‘youth-educators-for-succession (YES)’ groups; women are organized in ‘Be-Model-Women (BMW)’ groups; and community elders coming from different walks of life are organized in ‘Joint-Action-Leaders (JAL)’ groups.

Youth Educators for Success (YES) groups: One YES group was formed in each woreda. Each group has 15 members representing both sexes. YES group members were selected using pre-identified criteria. They were trained in both technical and facilitation skills. Technically, they were given tailored trainings on topics such as RMNH, gender rights and harmful customary practices (HCPs). In addition to that they were given training on community conversation (CC) facilitation skills. After getting those technical and facilitation skills trainings the YES groups were deployed to their respective communities to organize and conduct household, neighborhood as well as community level community conversation sessions specifically with youth groups/ their peers. They are expected to work in close collaboration and partnership with local level health practitioners including the health extension workers (HEWs), health development army (HDAs) and staff of woreda health centers. The major duties of the YES group are:

(i) Personal contacts: where members of YES conduct one-to-one or small group education with their peers when and where possible;
(ii) Techno contact: where members of YES produce local songs and role plays on issues of RMNH, gender right, HCPs; record them on mobile memory chips, and distribute to their peer groups so that the youth will listen to the songs using their mobile phone;
(iii) Professional contact: besides educating their peers through person to person and memory chips approaches, YES groups are also playing the role of creating referral linkages with local health facilities.

Members of YES get various forms of rewards based on their achievement records. The awards include but not limited to mobile phones, goats, vocational skill trainings, etc. Annually 100 best achieving members are nominated and get such awards based on criteria developed jointly with them.

Be-Model-Women (BMW) groups: Again one BMW group was formed in each woreda. The BMW group was formed by women who are currently using RMNH services. Each BMW group has 15 members. Members were trained on technical and facilitation skills similar to the ones given to the YES group. The role of a BMW member is to act as a role model to convince another woman in her circle of influence to go to health centers and use RMNH and other health services there. If a member is able to convince 10 women to use RMNH services, she then graduate to ‘money for women (MfW)’ group and enjoy the benefit of getting small business development trainings and the provision of small ruminant (one goat) as a means for generating her own income.

Joint-Action-Leaders (JAL) group: It is known that women issues are best addressed by involving men and the rest of the community. To this effect, a JAL group was formed one in each woreda. The JAL groups consists of teachers, health practitioners, religious leaders, opinion leaders, political leaders, police & the judiciary, elders, business men, etc. They were constituted as JAL and their role is to work as change agents to the betterment of lives of women and youth in particular and the community at large. In addition to technical skills trainings similar to the ones given to the YES and BMW groups, they were also trained with local level leadership skills. They serve as ambassadors to promote the pressing issues of women and youth in their area and to arrange local level dialogues in their respective constituencies. For example religious leaders arrange and conduct dialogue in their religious constituency, teachers with their school community, elders in their village-gatherings or mahiber, etc.

Strategy #2: Money for Women

With the prevalence of a male-dominant system and women having no meaningful power in societies, it is hard to talk about equity. To have equitable systems in place and see women making decisions about matters that affect them, there is a need to empower them both economically and socially. In Afar region, as it is common in the rest of the regions, women’s social position and economic power is not that much developed and equity is a thing of only the future. So it is empirical to take equity measures to improve women’s position and help them access needed services by their own choices. Organizing women in income generation activities (IGAs) and supporting them to help each other will meet these social and economic empowerment needs of women. Members of the BMW group form a women-goat-saving group in which the members are given goats on a revolving fund mechanism. Using this mechanism the woman who receives a goat will pass its offspring to the next qualifying woman in her BMW group.

Strategy #3: Service Quality Promotion.

One of the most important barriers to the uptake of RMNH services by women and youth is the poor quality of health services. There are a number of reasons for that. But, providing quality, client-friendly & culturally-responsive/sensitive health service is believed to improve women’s demand for the use of health facilities available to them. Using this project we want to improve the quality of health services through providing a number of competence building and motivational trainings to local health practitioners, through increasing the number of female health service providers as there are cultural barriers the use of modern delivery through male birth attendants in the area.

Using these innovative and comprehensive project approaches, we believe that we can contribute to the realization of the four output areas of the RIF project, in the form of (i) increasing uptake of culturally acceptable and appropriate RMNH services for women and youth in the 14 selected woredas of Afar National region (33%); improving community’s attitude to RMNH needs of women and youth (50%); empowering women and making them to be confident to make healthy RMNH choices and access services (10%); and ensuring enhanced accountability and responsiveness of woreda and higher level health providers to the Afar community in general and the women in particular (75%).

Achievements of RMNH project in Afar Region

- 1000 pregnant women attended antenatal care at least once during their last pregnancy ANC (proportion of increase from the current baseline)
- Teenage pregnancy reduced (proportion of reduction from the current baseline)
- 1000 pregnant women attended their last delivery at health centers
- 75 health workers trained on Reproductive maternal and neonatal health.
- 5,000 youth, more than 50,000 women & community members reached with RMNH information
- 140 religious and community leaders trained and oriented on local level leadership
- 14 facility management boards (JAL – joint action leaders) established and strengthened
- 800 women and girls reached with culturally relevant business development initiatives
- 20 songs & role plays on issues of RMNH, FP, Gender Rights & HCPs were produced, recorded and distributed; 150 awareness raising campaigns conducted; 5000 brochures were produced and distributed; and 560 T-shirts were produced and distributed.