1. SLIDE 1 Cost recovery Auto-rickshaw (Bajaj) model for Family Planning Outreach services in Dar es Salaam Tanzania: An innovative Approach Authors: Diana Karioki 1, Jeremiah Makula 1, Hussein Abdallah 1, Festo mboya 1, Liliani Charles 1,Mengi Ntinginya 1, Mwemezi Ngemera 1, Olivia Nuccio 2 Presenter: Kath Desmyth Marie Stopes Tanzania

2. SLIDE 2 Background and Objectives Background Traditionally, provision of health services using an outreach model have been aimed at rural populations. MST has a large outreach program, 24 teams who deliver services to rural and remote areas. However, recognising the gap in service provision to slums and informal settlements, MST initiated a pilot project to test a model of service provision more suited to peri-urban areas, using three-wheeled Bajajis. Objectives The project aims to increase access to FP in densely populated suburbs of Dar es Salaam Contribute to economic development in the local community

3. SLIDE 3 Why this Bajaj model is an innovative approach for delivering FP services? Bajaj outreach model  Trained family planning (FP) nurses visit peri-urban areas in a 3-wheeled bajaj  Free FP counseling and services provided at local health facilities  Strong partnership with local government authorities (LGAs) and health workers  Demand generation through volunteer community-based mobilisers (CBMs)

4. SLIDE 4 Why the Bajaj model is an innovative approach for delivering FP services? Cost Recovery  ‘Owner-drivers’ sign hire-purchase contracts for the Bajaj (Interest free microfinance loan)  MST is charged a reduced rate of 500TSH/km when transporting the nurse to and from health facilities. The amount is deducted from the loan.  Monthly cash repayment (50,000) from profits of running Bajaj as a taxi

5. SLIDE 5 Why the Bajaj model is an innovative approach for delivering FP services? Cost Recovery  Transporting MST nurse to outreach site 5 days a week  Demand generation while carrying out “normal” Bajaj business  Drivers cover all running costs (fuel, maintenance)

6. SLIDE 6 Why the Bajaj model is an innovative approach for delivering FP services? Youth friendly  Client Advisory Committee (CAC) established  Group of 14 young people that provide regular feedback on how we should improve our services to make them more youth friendly.

7. SLIDE 7 Impact of the project FP Services 27,656 underserved women and men in the peri-urban areas of Dar es Salaam have been reached 41% under the age of 25 Total annual impacts20132014 Unintended pregnancies averted 180,153154,287 Abortions averted 25,63621,955 Maternal deaths averted458393 Unsafe abortions averted24,54921,024 Service Provided Tubal Ligation187 Vasectomy27 3 year Implant9,395 5 year Implant5,300 IUCD4,158 Injectable7,178 Pills circles4,221 NO. condoms3,308

8. SLIDE 8 Impact of the project Cost recovery 100% of the total purchase price (5.5 million TZS) has been recovered up to July 2014 for all bajajis. In 2014 all of the drivers became owners of their Bajaj MST have purchased 5 new Bajajis

9. SLIDE 9 Impact of the project Economic development of local community Employment opportunities Significant improvement to lives of the drivers and their families The drivers renovated their houses/rooms The drivers have now become employers

10. SLIDE 10 Conclusions MST is continuing to expand access to and utilization of FP services in peri-urban populations in the areas where availability of such services is limited and the use of a normal outreach team model will be more expensive. The cost recovery component ensures sustainability of the project; Enables low income youth to own the bajaj and improve their livelihood Funds recovered from one off-set bajaj will be used to purchase new bajajis which will allow for continuation of service delivery.

11. SLIDE 11 Thank you!