|
Conference Proceedings 2000
Findings On Reproductive Health Of Refugees
And Displaced Populations
Washington DC | December 5-6, 2000
Challenges in Implementing Reproductive Health Programs in Complex
Emergencies
| Moderator: Maurice Middleberg, CARE |
Presentations:
| Claire Hoffman |
Community participatory family planning and reproductive
health with internally displaced communities, Sri Lanka |
| A. Sam-Abbenyi |
HIV/STD prevention among the returnee and resettled
population of Gitarama, Rwanda, 1996-2000 |
Carolyn Baer
Neena Philip |
Knowledge, attitudes and practices of reproductive
health, Kajo Keji County, Southern Sudan |
|
| Community participatory family planning and reproductive
health with internally displaced communities, Sri Lanka
Abstract revision date: December 5-6, 2000
|
| Authors |
Claire Hoffman, International Planned Parenthood Federation
(IPPF), London Family Planning Association of Sri Lanka |
| Presenter |
Claire Hoffman |
| Background |
Sri Lanka has faced an unprecedented problem of internally
displaced persons created in the wake of escalated ethnic
strife plaguing the country for the last 15 years. There
are a reported 400,000 internally displaced families living
in centres located mostly in border areas of conflict
zones. Whilst bare essentials such as food, clothing and
shelter have been provided, health care has been grossly
neglected. |
Purpose of study
or program |
The Family Planning Association (FPA) of Sri Lanka -
an affiliate of IPPF - designed a project with the overall
goal of raising the health conditions of displaced communities
to be at par with the national average. |
Data collection
methods |
|
Study or
program findings |
Increased CPR among married couples
The project saw a significant increase in the Contraceptive
Prevalence Rate (CPR). The baseline survey showed that
40.06% of 11,271 eligible couples were practising a method
of FP; of this modern methods accounted for only 33%.
At the end of the project (January 2000), FP practice
levels ranged from 40.6% to 69%, of which modern methods
accounted for 57.5%. In some of the camp clusters, the
rate had doubled.
Increased community awareness and involvement in
providing FP and RH services
By the end of the project, community camp leaders were
well informed about the FP and RH needs for the total
well-being of the community. They had been fully involved
in addressing the FP and RH needs and had provided leadership
to health volunteers and CBDs. Overall, community participation
throughout the project was at a high level.
RH information and counseling to adolescents
As part of an extension to the initial project, young
people's needs were addressed. Some 66 young people
were trained as peer educators, each of whom educated
at least 20 other youths and have continued their support
role. Counselling services for young people at the camp
level were introduced with 52 suitable individuals trained
to work as part-time counsellors.
|
Conclusions
and program
implications |
A number of key lessons were learned during the implementation
of this project, some of which were not necessarily explicit
in the initial design of the project.
Community involvement
A key element to the success of the project was the involvement
of beneficiaries at all stages of project implementation.
Adolescent reproductive health needs must be addressed
Addressing the needs of, and involving, young people was
an element that was initially missing from the project.
The clear conclusion was that young people's RH needs
should be an integral element in every RH programme.
Empowering women
Although the primary objective was to promote FP and RH,
the project also played an important role in empowering
women. More than 50% of health volunteers were women,
and the project has directly and indirectly assisted reproductive
rights among women.
Success in seemingly impossible situations
Initially the Sri Lanka FPA had been cautioned by health
and public officials that FP promotion among the primarily
Muslim displaced population was an "impossible" task.
Nevertheless, after some initial opposition, contraceptive
acceptance was significant - largely due to community
involvement, participation and leadership in the project. |
For further
information |
Claire Hoffman, Advocacy Officer, IPPF, Regent's College,
Inner Circle, Regent's Park, London NW1 4NS
UK
Telephone: +44 (0) 20 7487 7856
Fax: +44 (0) 20 7287 7865
Email: choffman@ippf.org |
|
| : |
| HIV/STD prevention among the returnee and resettled population
of Gitarama, Rwanda, 1996-2000 Abstract revision date:
December 5-6, 2000
|
| Authors |
A. Sam-Abbenyi, U. Korus, P. Crussard, T. Ndibeshye,
CARE Rwanda |
| Presenter |
A. Sam-Abbenyi |
| Background |
CARE Rwanda implemented an HIV/STD prevention project
in 3 phases using peer educators/health animators (HA)
in Gitarama, Rwanda. Beginning in 7 communes in 1996,
the project progressively covered all 17 communes in
Gitarama Region by 1999-2000. In the aftermath of genocide
in 1994, the project was designed to help the Ministry
of Health (MOH) revitalize HA networks after refugees
returned to Gitarama after the war.
Promiscuous life in refugee camps in eastern Congo,
lack of information and education on HIV/STDs and inadequate
STD services contributed to greatly increased prevalence
of HIV/STDs in Rwanda. The MOH wanted to concentrate
health animator efforts in this domain. |
Purpose of
study or program |
- To measure changes in returnees' knowledge, attitudes
and practices (KAP) of HIV/STDs in all 3 phases
of the project.
- To ensure a smooth phase-over of the health animator
network from CARE to the Gitarama Health Region
(GHR) and build the capacity of the GHR to oversee
community-level education and condom distribution
for HIV/STD prevention.
|
Data collection
methods |
Between 1996 and 2000, 4 KAP studies were conducted
using two-stage cluster samples. During the same
period 3 qualitative studies were undertaken using focus
group discussions and in-depth interviews of key informants. |
Study or
program findings |
Revitalized health animator activities resulted in
improved knowledge and use of STD services: over 95%
of both sexes cited 2 or more STDs. Female youth under
20 years had lower levels of knowledge than males. Condom
use increased: ever-use of condoms was reported by 16.9%
of women in 1999 versus 9.3% in 1996. Women's use of
condoms during last intercourse rose from 4.4% to 9.3%.
Men's ever-use of condoms rose from 10.8% to 20% and
use of condoms during last intercourse increased from
7% to 9.4% in 1999. Condoms were not used because of
trust in partners (that they were not infected), belief
that spouses/partners were faithful, or condoms were
not available. Only 200 HAs (18.2%) sold condoms, accounting
for 7.5% of total condoms sold/distributed. HA's did
not sell for reasons of religion or comfort level. Patient
consultations in health facilities for STDs increased
six-fold from 0.9% in 1998 to 5.4% in 1999. |
Conclusions
and program
implications |
The challenge to maintain community outreach networks
is twofold: the GHR requires a budget line for HA activities
and the annual HA drop-out rate of 20% is high. HA's
are volunteers and need to be organized in resource-generating
associations. Future HA selection criteria may need
to include a desire to provide contraceptive/condom
messages and services. There is a need to focus more
on youth to prevent HIV transmission. |
For further
information |
A. Sam-Abbenyi, MD, MSc, Reproductive Sector Coordinator,
CARE Rwanda, Box 550, Kigali, Rwanda
Telephone: 250-72402, 72907
Fax: 250-76012
Email: abbenyi@rwanda1.com |
|
| Knowledge, attitudes and practices of reproductive health,
Kajo Keji County, Southern Sudan Abstract revision date:
December 5-6, 2000
|
| Authors |
Neena Philip, Intern/Consultant, American Refugee
Committee, Southern Sudan |
| Presenter |
Carolyn Baer, American Refugee Committee, and Neena
Philip |
| Background |
Kajo Keji County is one of the southernmost counties
in Sudan with approximately 120,000 people, more than
43,000 of whom are internally displaced persons. Since
1994, ARC has been providing primary health care (PHC)
services; reproductive health services were introduced
in 1998. |
Purpose of study
or program |
- To obtain information that would assist in efforts
to ensure that PHC (including reproductive health
and water/sanitation) program activities in the
county are appropriate and effective in meeting
the priority needs of the community (county).
- To obtain information from which program effectiveness
can be assessed; and
- To provide ARC, SUHA (indigenous health NGO),
SRRA authorities and the County Health Department
staff experience in development, implementation
and analysis of a comprehensive survey.
|
Data collection
methods |
Sample population: men and women 15-45 years old.
Sample size:1,211 men and 1,786 women in 1,130 households
Survey Area: Kajo Keji County, southern Sudan
Study Design: Interviews were conducted for 3 weeks
in July 2000 using a 40 cluster sampling design consisting
of 45 females and 30 males per cluster.
Survey instrument: 3 instruments were used: a women's
survey, a men's survey and a household survey translated
into Dinka, Bari and English
Interviewers: 102 interviewers (21 female) who were
involved in the PHC system and who received a 4-day
training. |
Study or program
findings |
Maternal and Newborn Care (parous women)
- 82% had seen a trained health care worker
during their most recent pregnancy.
- 56% were able to list 2 complications
during delivery that would require assistance from
a health worker.
- 53% had a trained attendant at their last
delivery.
STD/HIV/AIDS (all respondents)
- 78% were able to cite 3 (of 4) modes of
HIV transmission.
- 36% were aware that condoms can prevent
HIV transmission. Condom use among those who are
aware is 43%.
- 65% believe that STDs cannot be asymptomatic.
Family planning/child spacing
- Among males, 52% are familiar with 2 or
more methods of family planning.
- 40% of respondents currently use a child-spacing
method (46% abstinence, 25% condoms).
- 70% stated 2 years or more is the best amount
of time between births.
Sexual and gender-based violence
- 63% of all respondents stated that females
are forced to have sex against their will.
- 69% of all respondents stated that men
have a right to beat their partners.
- 17% of the women stated that they had
been hit or beaten by their boyfriend or husband
within the previous month.
|
Conclusions and
program implications |
- Continue efforts to increase knowledge
of reproductive health issues.
- Build effective campaigns based on current
levels of knowledge to encourage practices which
lead to improved RH (use of condoms, child spacing,
reduction in violence).
- Continue to monitor population's knowledge,
attitudes and practices in order to assure effective
programming.
|
For further
information |
David and Paulette Hassell, Co-Country Directors,
Carolyn Baer, RH Coordinator, ARC International Southern
Sudan/Uganda Programs, PO Box 7868, Kampala, Uganda
Fax: 256-41-533737 Email: arc@swiftuganda.com
Neena Philip Email: neenaphilip@hotmail.com
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Next: Family Planning -
An Ongoing Challenge
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