The synergistic relationship of institutionalization and expansion: - - PowerPoint PPT Presentation

The synergistic relationship of institutionalization and expansion: Lessons from scale-up of youth-friendly services in five countries

Gwyn Hainsworth, Deputy Director of Technical Services, Pathfinder International/E2A

BACKGROUND

• Large adolescent and youth population with disproportionate

burden of poor SRH outcomes

• Youth-friendly services (YFS) that are equitable, accessible,

acceptable, appropriate, and effective can address access barriers

• Many countries have YFS
• n a limited scale
• How to scale up YFS to

achieve adequate coverage?

METHODOLOGY: THE EXPANDNET FRAMEWORK

The innovation: Youth-friendly SRH services Resource team: Pathfinder, UNFPA and partners, including experts from user orgs User organization: Ministry of Health and NGOs/FBOs Scaling-up Strategy Type of scaling up: Expansion and institutionalization Dissemination and advocacy Organizational process Costs/resource mobilization Monitoring and evaluation

The elements of scaling up Strategic choice areas

Environment

INNOVATION: YOUTH-FRIENDLY SERVICES

Characteristics of the innovation – Package of SRH services offered by trained providers at public-sector facilities and (depending on country) through private facilities, workplace programs, and CBD. – Emphasis on privacy, confidentiality, respectful treatment, free or subsidized services – Accompanied by demand generation and enabling environment activities – Emphasized youth participation and leadership in program design and implementation

SCALE UP APPROACH

Institutionalization (Vertical scale up) Expansion (Horizontal scale up)

BOTH institutionalization and expansion were pursued contributing to the sustainable scale-up of YFS

INSTITUTIONALIZATION

Mozambique Ghana Tanzania Vietnam Ethiopia Policies & guidelines supporting YFS

• • • • •

National YFS curricula & training network

• • • • •

Incorporation of YFS in national preservice training

• National YFS tools
• • • • •

YFS integrated in NGO/FBO service delivery system

• HMIS age disaggregation
• •
• YFS in national/regional/district budgets & workplans
• • •

Mozambique (Geração Biz)

Phase 1 1999-2000 Consensus building; pilot introduced to 12 sites in 2 provinces Phase 2 2000-2005 Expansion to 83 sites in 8 provinces Phase 3 2005-2008 Expansion to 244 YFS sites in 11 provinces (nat’l scale) Phase 4 2008-2012 System strengthening & capacity building; transition to government Ethiopia (RH/FP Project and Integrated Family Health Program ) Phase 1 2005-2007 Consensus building; study tour to Mozambique; pilot in 20 YFS sites in 4 regions Phase 2 2008-2009 Expansion to 64 YFS sites in 4 regions Phase 3 2010-2011 Expansion to 115 YFS sites in 4 regions Phase 4 2012-2014 Expansion to 163 YFS sites in 6 regions; transition to government

EXPANSION

Vietnam (Reproductive Health Projects) Phase 1 2004-2006 Consensus building; study tour to Thailand; pilot of 5 YFS sites in 3 provinces Phase 2 2007-2008 Expansion to 19 YFS sites in 7 provinces Phase 3 2009-2011 Expansion to 28 YFS sites in 17 provinces

Ghana (African Youth Alliance) Phase 1 2000-2001 Consensus building Phase 2 2002 YFS introduced in 19 sites in 3 regions Phase 3 2003-2004 Expansion to 65 YFS sites in 5 regions

Tanzania (African Youth Alliance) Phase 1 2001 Consensus building Phase 2 2002 11 YFS sites introduced in 4 regions Phase 3 2003-2004 Expansion to 58 YFS sites in 8 regions

SYNERGIES BETWEEN VERTICAL AND HORIZONTAL SCALE

• Supportive policy environment (under

institutionalization) provided needed mandate for expansion of YFS

• YFS expansion led to greater service use and

generated momentum—holding gov’ts accountable for fully operationalizing adolescent health policies

• Timing was key!
• First expansion occurred soon after creation of

supportive policy environment

• Investment in development and dissemination of tools

and technical resources (e.g., network of YFS trainers) allowed for efficient scale-up, achievement of economies of scale and sustainability

• As YFS was expanded, needed system changes or tool

development identified to ensure fidelity to the innovation during scale up

PURSUING VERTICAL AND HORIZONTAL SCALE SIMULTANEOUSLY INCREASES SUSTAINABILITY

• Factors influencing sustainability:

– Degree of expansion (horizontal scale): National or close to national scale can help mitigate staff turnover and create high visibility of YFS making it harder to dismantle – Extent of institutionalization (establishment of systems to support YFS delivery, incorporation of YFS into relevant budget lines, and integration of YFS within preservice education)

• Capacity building of MOH and NGO staff critical for supporting expansion

and institutionalization of YFS and incorporation of YFS within national, regional and district budgets and workplans

• Internal funding for YFS and less reliance on external funding is a crucial

factor to long term sustainability

CONSIDERATIONS WHEN SCALING-UP A YOUTH- FOCUSED INTERVENTION

• Young people’s lack of political voice requires greater advocacy to ensure

expansion and institutionalization of youth-focused interventions

• Partner with health systems strengthening efforts to ensure age-

disaggregated HMIS and that youth-focused interventions are included in national supervision and quality improvement systems

• Adult bias requires additional efforts to shift attitudes and commitment to

addressing young people’s health needs

• Lack of donor commitment may require innovative funding strategies and

capacity building from of gov’t counterparts to include youth-focused interventions within budgets and workplans from the onset

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