She Knows Best: Engaging Girls in Adolescent Programming

"'She knows best: Engaging girls in adolescent programming' highlights the strategy developed to address foundational facility and community-level barriers that prevent adolescents from accessing and receiving quality SRH [sexual and reproductive health or ASRH - adolescent SRH] services."

The International Rescue Committee piloted a new approach to increase access to SRH care for adolescents in three health facilities in Goma, Democratic Republic of Congo, with the support of the David & Lucile Packard Foundation. The three-pronged approach included:

• "Increased provider capacity: The IRC conducted a series of activities including ASRH training, Values Clarification and Attitude Transformation Activities (VCAT) and targeted supportive supervision..." beginning with results from health provider knowledge, attitude, and practice (KAP) questionnaires that showed poor attitudes toward adolescents.
• "Improved facility readiness: Baseline and endline facility assessment helped measure facility readiness and recognize areas for improvement. Reorganization to ensure confidentiality and privacy of services and monthly adolescent SRH data review meetings were key."  Workshops and briefings familiarised health providers with new adolescent SRH supervision and data collection tools.
• "Meaningfully engaged adolescents: The IRC's success can be credited to the direct involvement of adolescents in participatory workshops, monthly meetings, joint supportive supervision and data review visits and innovative outreach and mobilization activities led by the adolescents themselves." The IRC organised their research around the following questions: 
• "What are the sexual and reproductive health needs of adolescent girls in Goma, DRC?
• What services and actors address the sexual and reproductive health needs of adolescents in the area, do they address the needs adolescents themselves prioritize, and what are the gaps that still remain?
• What are the main barriers to sexual and reproductive health for adolescents that the project should address?"

In order to conduct the participatory assessment, six adolescent girls and health providers were trained to co-facilitate workshops for 40 in and out of school adolescent girls and health providers. Results included the barriers of staff attitudes, poor reception of adolescents trying to access services, and attitudes of parents who may not encourage their daughters to access services. The discussions also revealed lack of information on anatomy of sexual function and pregnancy prevention. In a second stage meeting, "participants prioritized areas of action to improve uptake of adolescent family planning services, identified assets within the community, and developed an action plan for each catchment area. Twelve adolescent girls and six health providers formed coordinating committees to implement the actions. They met on a monthly basis to monitor progress and participated in IRC supervision visits to the facility."

The coordinating committees "addressed the lack of information on adolescent SRH, explained the benefits of contraception for adolescents, and challenged the stigma around adolescent contraceptive use" through "sensitization activities for mothers of adolescent girls in hair salons, fish markets, charcoal stands, and partnered with female-run local business associations to deliver messages during their meetings." They took information for adolescents to local schools and orphanages, functioned as peer educators, and accompanied girls to the health care facilities. In addition, committees addressed service delivery through formal trainings and focused supportive supervision and worked to ensure clear confidentiality policies visibly posted, as well as outreach messages emphasising the availability of confidential services.

In addition to the increase in adolescents who adopted new methods for contraception, there were lessons learned, including:

• "STI care can serve as a key entry point for adolescents in Goma. Adolescents reported that discussing STI care with their peers is at times easier and more acceptable than discussing the need for other SRH services.
• Engaging adolescent boys, parents of adolescents and other influential adults may strengthen the approach. Data from the participatory assessments indicate that these key stakeholders strongly influence adolescent access and use of services.
• There is a latent demand for comprehensive abortion care services. Adolescents reported that girls in their community sought abortions through existing, informal networks."

With the aim of "substantially improve the humanitarian field’s understanding of the most effective combination of interventions to improve adolescent SRH, client responsiveness and adolescent-inclusiveness in acute emergencies," the IRC plans to "conduct operational research to evaluate and compare the feasibility and effectiveness of implementing two different packages of interventions aimed at increasing access to, quality of, and demand for adolescent SRH services" in DRC. It plans to address facility and community-level barriers, "integrate Participatory Action Research with adolescents and key influencing groups into the core ASRH intervention package to increase adolescent engagement and ownership of health programs and improve community support for adolescent health services," and "evaluate the effectiveness of each intervention package by measuring the use and quality of ASRH services at baseline and endline."