In Ethiopia, We’re Going to Scale — Nationwide

Through RISE, the Ethiopian Ministry of Health, with an investment from the Children’s Investment Fund Foundation and with technical assistance from PSI, will integrate Smart Start into Ethiopia’s national Health Extension Program – bringing Smart Start to 1 million girls by 2025.

When PSI launched Adolescents 360 (A360) Ethiopia in 2016, we pledged to innovate youth contraceptive programming.

The result? Smart Start. 4 years later? The program is going nationwide.

Developed with and for Ethiopian young people, Smart Start flips the traditional contraceptive counseling conversation – leading with targeted financial messaging designed to help rural Ethiopian girls aged 15-19 and their husbands plan for the families, and lives, that they want.

From the start, our goal centered on serving the hardest-to-reach Ethiopian girls, their husbands and the health system on which they rely. And with three in four girls who engage with Smart Start opting for a contraceptive method, we knew that institutionalizing the work offered a roadmap to reach every girl who needs Smart Start, the most.

Through RISE (Roadmap for Integrating Smart Start in Ethiopia) – an initiative funded by the Children’s Investment Fund Foundation and supported with technical assistance from PSI — the Ethiopian Ministry of Health is scaling Smart Start nationwide, supporting 1 million rural, married Ethiopian girls aged 15-19 to access contraception by 2025.

 That’s impact at scale.

Credit: Benjamin Schilling

Why this Matters

In Ethiopia, 4 in 5 girls will have a baby by age 20, often before considering the financial implications of having a baby before they are ready.

In rural Ethiopia, home to three in four of Ethiopian girls aged 15-19, girls often take up their first method of contraception at age 24, well after giving birth to three or more children.

The financial and health implications of too early and too frequent births ripple across families and among communities.

Smart Start, awarded in 2019 as a Goalkeepers Accelerator, supports young rural couples to identify the resources they’ll need to achieve their life goals, including a family when they are ready. And it equips community-based Health Extension Workers with a tool that speaks directly to girls’ self-defined dreams, with an understanding of how contraception can help girls to achieve their life plans.

Credit: Benjamin Schilling

Adolescents 360? Smart Start? RISE? What’s the difference?

A360 is the origin project from which Smart Start – A360’s project in Ethiopia – was born. RISE is the next phase, aimed at scaling Smart Start across six regions of Ethiopia.

RISE is much more than a youth contraceptive program; it is a movement designed to support young married women identify their life goals, plan for the families they desire and take charge of their lives. At the same time, it underscores PSI’s global commitment to innovation, to foster partnerships with health systems and diverse actors and to deliver client-centered care.

Credit: Benjamin Schilling

What Did We Learn About Influencing Government Decision-Making?

Influencers who can influence government decision makers across levels and departments is key (which, in Ethiopia, included embedding a PSI point person in the Ministry of Health). Young designers are powerful advocates in bringing government representatives along on the journey, too.

Credit: Geremew Tigabu
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