Reproductive Health

Background:

At the Cairo International Conference on Population and Development (ICPD) in 1994 the world community declared the right of every human being to reproductive health. Reproductive rights include the right to decide freely concerning marriage and the number of children one will have and about the spacing of children and the timing of births, the right to access good quality reproductive health services and the right to freedom from sexual coercion and sexual violence (see ICPD Programme of Action).

Component objective:

The population in the programme regions, particularly young people, have access to information on sexual and reproductive health and is increasingly using selected good quality reproductive health services.

Approach:

The component focuses on collaboration with different stakeholders at all levels, stressing inter-sectoral collaboration.  At the national level, the component is attached to the Ministry of Health through its Reproductive and Child Health Section within the Department of Preventive Services. Technical advice and support are provided to various partners (regional and district institutions and NGOs) in the focal regions.  In addition, development of information media in particular for a young audience is one of the focus areas of the component. Realising the importance of partnership, ownership and learning from best practices, the component emphasises multisectoral collaboration in the following sectors: health, education, community development and youth. Activities are developed through a participatory approach involving all stakeholders.  Areas of support reflect district priority needs.

Currently, the component focuses on providing adolescents in and out of school with comprehensive information on sexual reproductive health and HIV/AIDS and increasing the availability of contraceptive options in rural areas.

For more information see “ Prevention and Awareness in Schools of HIV/AIDS”

Activities

1. Support to a community based approach in order to increase access of communities to sexual and reproductive health and HIV/AIDS information, and of women, men and adolescents to family planning services.
2. Training of service providers for community based distribution (CBD) of contraceptives including some selected HIV/AIDS intervention such as home based care; follow up of mothers who have just delivered and on referral procedures for people in need of long term permanent contraceptive methods, STI treatments and fistulae repairs.
3. Development of series of information and education materials related to sexual reproductive health including life skills, STIs, HIV/AIDS.
4. Support to the development and implementation of peer education activities in primary and Secondary schools
5. Information and services for out of school adolescents, via working with traditional initiators, theatre groups and youth groups
6. Broadening contraceptive choice by support to training of health personnel in long-term/permanent contraception, update of family planning providers and piloting emergency oral contraception.
7. Support to comprehensive women’s health services in close cooperation with an integrated expert from CIM in Lindi regional hospital.  Some of the activities include capacity building by continuous on job training, updates for trained service providers in life saving skills, care of mother and baby before and after delivery, provision of essential equipments. Others interventions are comprehensive post abortion care, screening for cervical cancers and repairs of fistulae.
8. Support action / operations researches / studies for improvement.

In the regions of Mtwara and Lindi there is a particularly intensive collaboration within the TGPSH. In Lindi, DED supports the regional hospital with a gynaecologist advising on HIV/AIDS-related activities in close cooperation with another gynaecologist provided as an integrated expert by CIM.

Community-based services have made a major contribution to more than doubling the number of clients for family planning in areas that have such activities. We currently have approximately 1,000 people trained by TGPSH as voluntary community-based distributors (CBD) in Tanga and Lindi regions. Experience shows that the resistance to making use of reproductive health services is considerably lower when these services are offered by members of the local community. The services of CBDs in the communities are very popular.

The work of the volunteers is extremely successful. Within a year of their introduction they had distributed more contraceptives than all the health services in the area put together. And that was not their only success. Their educational activities have boosted the numbers of those requesting family planning services at health service facilities. Men in particular appreciate having the opportunity to talk to and receive information on family planning and condoms from someone other than the health service staff, who are strongly geared to women and their needs.

Impact – what has been achieved

In the areas where community-based reproductive health services have been actively promoted, about 40 % of women are using contraceptive methods. Trained volunteers represent a source of information on different sexual health and HIV/AIDS topics, and at the same time refer clients to health services for other services. They successfully initiate discussions on sensitive sexual matters such as gender violence, customs influencing sexual behaviour as well as HIV/AIDS in their community. Traditional initiators are showing great interest in discussing and receiving information on HIV/AIDS and other health topics. Some of these new information topics and ideas will hopefully influence the content of initiation ceremonies and teachings.

Peer education in elementary schools improves significantly the knowledge and attitude of adolescents towards sexual reproductive health and HIV/AIDS-related topics. The peer educators are respected by their peer, developed self-esteem, enjoy their task and do well in class. On the other hand pupils confirmed that it is easier and more productive to discuss sensitive issues with peers than with teachers or others adults. The information materials provided such as flyers, brochures and booklets as well as a bilingual website for teenagers ("Chezasalama") are well accepted  and are been recognized by adolescents, as well as by all stakeholders  working with young people.