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Promoting Adolescent Reproductive Health in northern Nigeria Yaikah Jeng Joof Trip Debrief TDY-1/08/10-1/18/10.

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Presentation on theme: "Promoting Adolescent Reproductive Health in northern Nigeria Yaikah Jeng Joof Trip Debrief TDY-1/08/10-1/18/10."— Presentation transcript:

1 Promoting Adolescent Reproductive Health in northern Nigeria Yaikah Jeng Joof Trip Debrief TDY-1/08/10-1/18/10

2 Overall Objective The main focus of this trip was to work closely with FOMWAN and the RL activities’ Consultant to review the implementation of the Religious Leaders’ activities in the 5 Local Government Areas (LGAs), in the states of Kano and Bauchi, as per their action plans, identify challenges in implementation and lessons learnt. Identify how the RLs and FOMWAN are working together

3 Background ESD + FOMWAN + COMPASS Engage Muslim RLs to improve reproductive health of married adolescents in Kano through promoting healthy timing and spacing of pregnancy (HTSP) and changing health seeking behavior. Target groups: key family members/community gatekeepers: (husbands, mothers-in-law, RLs in 5 Local Government Areas (LGAs)) Strategies: Capacity building of local partner (FOMWAN) through training Training of RLs to promote HTSP and support educational outreach to communities to improve the health of young married women Community outreach/mobilization in 5 LGAs: Kano (4), Bauchi (1)

4 Phase I: 2008-2009 – Training of 27 FOMWAN members on HTSP; completed May, 2008 – Training of 35 RLs to include RH/HTSP messages in their sermons February 2009; completed – Development of action plans (APs) by FOMWAN, Imams after trainings ESD Objectives

5 Implementation of activities Phase 2: Implementation of APs ( February-July 2010 ) -Training – FOMWAN to conduct state level step-down training for FOWWAN Executive Committee (EXCO) members in Kano and Bauchi (14 participants from Kano and 4 from Bauchi) – FOMWAN to conduct LGA level step down level training in 5 LGAs in kano State (Nassarawa, Dala, Gwarzo, Bebeji and Bichi) Community outreach – 5 or more educational/advocacy visits with influential community groups (traditional leaders, influential women), house-to-house visits, lectures at Islamiyya schools and wedding venues: mostly completed – Lectures at 50 Islamiyya schools (10/LGA) and 15 wedding venues (3/LGA): completed – House to house mobilization for 11 or more wards within the 5 LGAs – Dissemination of messages during Juma’a sermons

6 Trip activities A meeting with Ameera Aisha Hassan, Kano State Leader, FOMWAN and Fatima Abdul, Consultant hired to work on the data collection of the RL activities. Meeting with the Council of Imams and Council of Ulama representative Meeting with the Council of Ulamas (N=5) representative, our link to the Imams for the data collection + Ameera Aisha Hassan + Fatima Abdul, to discuss data collection. Travel to LGAs in Kano: – Nassarawa (5) – Dala (5) – Bebeji (5) – Gwarzo (5) – Bichi (5) Meeting with Imams in LGAs visited to discuss the messaging (Nassarawa, Gwarzo, Bichi), ensure that the correct messaging is being disseminated and explore their thoughts on the activity and its impact. Visits to Islamiyya schools in all LGAs visited Conduct some house to house visits

7 Meeting with Religious Leaders January 2010

8 Meeting with the Council of Imams

9 Visit to Dala Islamiyya School

10 Data collection flow chart Data Collection Methods: – Phone calls from Ulama rep. to Imams to obtain data (via notes) – Phone call/meeting between FOMWAN/Consultant and Ulama rep. for data review and filling of form; more communications between Ulama rep. and FOMWAN/Consultant for clarification (if necessary) – Also calls to Imams directly by FOMWAN, if necessary – Final report (form and some narrative) sent to ESD Imams in 5 LGAs Council of Ulama Representative Consultant/Ameera Aisha Hassan Report to ESD

11 Status of activities to date FOMWAN ACTIVITIES StatusChallenges (overall) State level step down training /orientation to FOMWAN EXCO members, on HTSP Completed (10 FOMWAN EXCO members trained) Positive male involvement; social pressures to bear more children; delaying early pregnancy/early marriage: not being well received; LGA level step down training for Islamiyya school teachers Completed (about 10 per LGA) Sensitization meetings at Islamiyya school graduations Ongoing (over 5000 reached) House-to-house visitsCompleted Meetings at community events (weddings, naming ceremonies) ongoingA slight delay due to Ramadan in November 2009 Advocacy visits (traditional leaders, Imams, RLs, women leaders, traditional leaders) Ongoing basis (600 women leaders)

12 Status of activities to date (cont’d) RL activities StatusChallenges (overall) Delivery of HTSP messages after Juma’a prayers by Imams Ongoing CounselingOngoing (approx. 5-7 per week) Community events (organized both by Imams and community committees) ongoing

13 FOMWAN recognized as HTSP leader in Kano With support from ESD and COMPASS, FOMWAN trained 35 RLs (February 2009). Results: Imams are doing counseling on RH/FP/HTSP (5-7 per week; 275 sessions to date) Imams include HTSP messages in Friday prayers Imams replicating training on their own initiative. From interviews with champions, estimation of close to 1000 RLs now disseminating HTSP (from 5 to 44 LGAs). Imams are also talking to their wives, who are also considered influential women in the communities. Increase in uptake of FP: Anecdotal information through unstructured FGDs led by FOMWAN outreach workers with community members. Project does not include facility-level data collection so ESD is discussing methods to get more accurate information IEC materials translated to Hausa/ printing: 4000 Hausa; 1000 English Major Achievements

14 Anecdotal evidence Dr. Dikko: – “I have seen a change in child spacing; it seems it is more common for mothers to space for 2 years” – “I am now seeing more young mothers asking for advice during their consultations with me: contraceptives, especially the injection” – “Currently we are seeing higher incidence of sepsis at Murtala Muhammad Hospital, mostly due to prolonged, obstructed labor, so advice/messages on age at first pregnancy, timing/spacing for next pregnancy especially critical”

15 Meeting with Dr. Dikko

16 Anecdotal evidence (contd.) Imam of Bichi “I am seeing girls, husbands, wives also. The HTSP messages are being received and accepted but they also want to hear about traditional methods” “just this week, I received about 5 different girls aged 19-25, who came to lament that they are still unmarried even after finishing school”

17 Visit to an Islamiyya School

18 Challenges Lack of community-based data (to determine impact of messages on the communities served) No access to health facility data Dependence on remote TA versus direct in-country support Low organizational capacity of FOMWAN -dependence on volunteers -one-woman show

19 Strategies to overcome challenges – Discussions underway to conduct a community- based survey to determine impact of our messages on the communities Sampling Questionnaire development – FOMWAN a “one-woman show” Local consultant has been contracted to focus on RL data collection and reports and remote TA, in collaboration with Ameera Aisha Hassan; will also use her as point person for community survey

20 Lessons learnt Choice of local Partner: – FOMWAN has strong community mobilization and outreach experience with women and religious leaders in Kano, but needs further organizational strengthening – FOMWAN has a strong network of contacts and has recognition among major stakeholders/partners in Govt./MOH Use of RLs – As community leaders, they provide inroads to communities’ psyches and perceptions and messages from them are very much accepted – Their wives are also key players in the communities and some of the Imams have already been talking to their wives about these messages Project design

21 Visit to Bebeji Hospital

22 Tiga Hospital

23 My eye-opener “””“there she lay on the stretcher, covered in a green lapa. For an instant, I wondered what “it” was!!!! Until I realized it was a woman who had died!!!!!””” After some probing, we found out she had had antepartum bleeding for about 2 days, delivered a still birth, and then developed PPH (another 2 days) all at home! IT TOOK HER RELATIVES 4 DAYS TO GET HER TO A HEALTH FACILITY BY WHICH TIME IT WAS TOO LATE!!!!!!!!! SHE WAS GONE!!! Imagine that!!

24 Thank you

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