The following was first published on Itad.com, A360’s third-party evaluator.
How might we better meet the needs of adolescent couples with contraceptive counseling and services through Ethiopia’s Health Extension Program?
This was the motivation behind the integration of Adolescents 360 (A360) into Ethiopia’s Health Extension Program (HEP). The HEP is largely attributed with a ‘significant and systematic’ increase in the modern contractive prevalence rate and health equity improvements. This includes for married, childbearing adolescents with no or little education or those living in rural areas. Despite these achievements, low utilization of and large unmet need for contraception remains among this population, alongside an increasing recognition of an overstretched HEP and overworked Health Extension Workers (HEWs), who are the ‘backbone’ of rural primary health care (PHC).
In the Ethiopian context, this has resulted in Smart Start, premised on the concept of joint financial planning as an entry point to discuss family planning with newly married couples. HEWs are central to the delivery of the program: each HEW is supported by a PSI Smart Start Navigator (SSN) to deliver couples counselling and family planning services (‘catch up’) but is subsequently left to continue the Start Smart program (‘keep up’) while the SSN moves to another location. Smart Start has been tasked with demonstrating its effectiveness to the HEP before the federal Ministry of Health (MoH) takes it over.
Through a participatory action research approach, Itad conducted research to understand how Smart Start can best be integrated into HEP. Findings are presented using the three areas of inquiry for the action research:
- The HEP
- The HEW
- The solution – Smart Start
This case study presents these findings and implications to guide PSI’s human-centered design (HCD) work with IDEO.org, with the HEW at the center.