Sigma AinulPopulation Council, the Evidence Project

Evidence Project IUSSP Side EventOctober 29, 2017

RESEARCH UTILIZATION TO IMPROVE NEW PROGRAMMING: ADOLESCENT FRIENDLY HEALTH CORNERS IN BANGLADESH

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1. Context and Background

2. Review and synthesis of ASRH programming in Bangladesh- what does evidence tells us?

3. Utilization of evidence and local context in ASRH programming- Bangladesh AFHC model

4. Assessment of the AFHC model- success and challenges

5. Use of evidence generated

Organization of the Presentation

Context and Background

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In Bangladesh, a large number of adolescents are sexually active due to high rates of child marriage, especially among girls.

Child Marriage

ADOLESCENT POPULATION: 36 MILLION

Two out of three (59%) girls marry before the legal age of 18

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High Adolescent Fertility

• Bangladesh adolescent fertility is highest in South Asia

• 15-19 age group contributes to one-fourth of the total fertility

• Adolescents enter into sexual life–poorly informed about SRH,

reproduction, protection and –without adequate access to SRH

related information and services.

Half of the women (49%) have given birth by age of 18

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• SRH policy and programs are largelydesigned for married women

• Unmarried are conspicuously missing in this discussion (until very recently)

ASRH Policies and Programs in Bangladesh

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Newsletter for ASRH Activities in Bangladesh

Review and Synthesis of ASRH Programming in Bangladesh:What does Evidence Tell us?

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Situation Analysis of ASRH: Published a Report and a Brief

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• Two-thirds (21 of 32 programs): SRH as primary focus

• Only half (16 of 32): exclusively on adolescents Only nine : primary focus on SRH and were exclusively focused on ages 10-19

Review of ASRH programming in Bangladesh

32 ASRH PROGRAMS IDENTIFIED

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ASRH Service Delivery Modality

4COUNSELINGTELE- COUNSELING

14CLINICAL

PROGRAMS

16NON-CLINICAL PROGRAMS

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+

SCHOOL

Facility based model

• Designed for larger reproductive age group (15-49) and maternal health

Community/safe space based model

• Group of adolescents meet • Limited counseling services

School based model

• Inclusion of SRH in National text book since 2012

⎻ Teachers are reluctant to discuss • School outreach by NGOs- single

dosage and not been effective

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• Safe space model, stand alone youth corners– Less acceptability from gatekeepers– Crowded by few segmented youth (girls are younger

adolescents are missing)– No trained SRH counselors– Referral linkage to SRH services is missing

• Facility based model– Barriers for unmarried as labeled as “FP clinic” – Served with older and bigger reproductive age group

Learnings Drawn from Review and Synthesis

Evaluation of the Government’s New Intervention:

Adolescent Friendly Health corners

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From 2016, The MOHFW, Government of Bangladesh, has setup AFHCs to extend SRH services to both married and unmarried adolescent girls and boys.

Marked signboard: AFHC and available services

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• Some show positive results in terms of SRH information(Speizer, Kouwonou, Mullen. et al, 2004; Neukom, and Ashford, L, 2003)

• Youth centers modeled at community space– Populated by older group of males– Used for recreational purpose and less effective for SRH

(Denno, Chandra-Mouli, and Osman, 2012); (Zuurmond., Geary, and Ross, 2012)

• Not cost effective, if compared with peer model (Erulkar, Beksinska, and Cebekhulu 2001)

• Providers’ bias and stigma in conservative setting (Jejeebhoy and Santhya 2014)

Global Evidence on AFHC

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• AFHC built on existing health facility; not stand alone– Family members and adolescents are familiar with

the physical location and the facility– Familiar with the service provider

• Clear demarcation about adolescent friendly corners and sign board about services available

• ‘Excuses’ services- checking of BP, nutrition, iron and folic acid, anemia, menstrual hygiene and counseling

Bangladesh AFHC Model

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Introduction of Adolescent Friendly Health Centers (AFHC) by Government

An Adolescent Friendly Health Corner (AFHC) at MaulivibazarMCWC. Adolescents can receive services and information here in a confidential and comfortable environment.

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Available Health Services and Service Providers

SERVICE PROVIDERS AT THE AFHC

Medical Officer

Family Welfare Visitors (FWV), and

Sub-assistant Community Medical Officer (SACMO)

Information and Counseling Services• Physical and psychological changes

during adolescence• Food and nutrition• Tetanus and other vaccines • RTIs/STIs• Menstruation and personal hygiene• Early marriage and early pregnancy • Contraceptives and family planning (to

married adolescents only)• Gender-based violence • Substance abuse

• Treatment for RTIs/STIs• Menstrual problems and

management • Treatment of anemia • Treatment for general health

issues• Tetanus vaccine • Referral services

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Districts Sl. LocationofAFHCsMoulvibazar 1 MCWC,SadarMoulvibazar

2 UHFWC,Fatepur union,Rajnagar upazila

Thakurgaon 3 MCWC,SadarThakurgaon4 UHFWCGangnipara union,

HaripurupazilaSirajganj 5 MCWC,SadarSirajganj

6 UHFWCRajapur union,Belkuchiupazila

Cox’sBazar 7 MCWC,SadarCox’sBazar8 UHFWC,Rashidnagar union,

RamuupazilaPatuakhali 9 MCWC,SadarPatuakhali

10 UHFWCPangashia union,Dumkiupazila

Field locations of AFHC Assessment Study

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Location

Total Number of adolescent (age 10-19)

Girls BoysMarried

girls Unmarried

girls

Reasons for visiting AFHC

General illness

SRH issues

ANC /PNC

PatuakhaliMCWC

380 373 7 135 245 255 70 55

SirajganjMCWC

348 337 11 46 302 309 37 2

Total 728 710 18 181 547 564 107 57

Percentage - 97.5% 2.5% 34.8% 75.2% 77.5% 14.7% 7.8%

Service statistics of AFHCs

January- September 2016 (Source: AFHC client register book)

Only 2.5% were boysAmong girls 75% were unmarried

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§ This intervention successfully pulled unmarried adolescent girls.§ Very few adolescent boys

§ Adolescent girls expressed overall satisfaction with the friendly behavior of the service providers.

Findings

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• Maintaining privacy is a challenge– Sometimes adolescents are served with out patients

• Gap in demand generation– Adolescent girls and community people are not well aware of

the new AFHS initiative

• Lack of BCC materials that covers range of ASRH and for different groups of adolescents

• Service Providers report overload• Shortage of medicine

Findings & Challenges

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• Revision in the training module• Review and refine AFHS criteria• Monitoring the quality and performance of

AFHC in regular basis.

The FP Program is Using the Results of the Study to Improve the AFHS Model

THANK YOU

The Evidence Project is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of cooperative agreement no. AID-OAA-A-13-00087. The contents of this presentation are the sole responsibility of the Evidence Project and Population Council and do not necessarily reflect the views of USAID or the United States Government.

The Evidence Project seeks to expand access to high quality family planning/reproductive health services worldwide through implementation science, including the strategic generation, translation, and use of new and existing evidence. The project is led by the Population Council in partnership with the INDEPTH Network, the International Planned Parenthood Federation, PATH, and the Population Reference Bureau.

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Ainul, Sigma. 2017. “Getting ASRH Evidence used in Bangladesh,” PowerPoint slides. Washington DC: Evidence Project.