By Beth Brogaard, Francophone West and Central Africa Regional Representative, PSI
Meeting consumers’ sexual and reproductive health (SRH) needs across fragile contexts requires that we account for the nuances of life in conflict – lessons that also apply to the current pandemic that has transformed life as we know it.
PSI’s work across conflict countries starts with these questions:
- How can we provide services when not all locations are safe to enter?
- What partnerships do we need to address the nuances of working among fragile contexts?
- How can we guarantee the quality of our services when we can’t always be on the ground?
These questions are grounded in the adaptation approach we employ. It’s a strategy that allows us to identify the risks to address; the safety measures to emplace; and the stakeholders – from administrative and public health authorities to community-level leaders, security personnel, consumers and frontline health actors –to safely and effectively reach vulnerable populations with the SRH services they say they want and need.
Across Mali, Cameroon and Niger, and through funding from Government Affairs Canada (GAC), we:
- Work with community leaders to secure safe access to public health sites, while engaging them as champions who can build trust among consumers;
- Partner with security and defense forces (including the UNDSS) to gain real-time information on terrorist operations that could endanger the areas in which we work;
- Develop digital systems for quality assurance;
- Build capacity among district-level health providers to implement youth SRH programming.
Our learnings from working across conflict zones have delivered a base for public health partners to use across all fragile settings – from countries countering COVID-19 to others battling rising insurgency.
We summarize those learnings, below. Curious to learn more? Give this webinar a listen.
1. Get serious on safety.
Safety of all – from consumers to health workers and your organization’s staff – is priority. Across our project sites, we limit hours in which staff travel – arriving well after sunrise (after 8 a.m.) and leaving well before sunset (before 5 p.m.). We share all routes with local security forces and no staff are permitted to stay in the field overnight for mobile activities. We build relationships and turn to community partners for security: for instance, informally we rely on links to motorcycle drivers, restaurant owners, small businesses within the community and traffic control officers to help us understand the security risk at the community level. We opt to suspend activities across high risk zones if violence and/or terrorist activity persist… and pause activities in areas with high (or increasing) COVID cases.
2. Build community trust by syncing up with local administrative authorities.
An enabling environment is key to entering and being accepted by communities – especially so in areas already on edge. In Mali, Cameroon and Niger, we never take part in any army escorts and only go forth with activities if we have administrative authority… once approval has been publicly announced to the community. Plus, we adapt messaging per the settings we operate in, an effort aimed at avoiding triggering a response from extreme religious groups within the community. With an eye to COVID, we work closely with our local counterparts to take the necessary precautions to keep all safe.
3. When it comes to the intersection of safety and services, engaging regional government brings in community-level stakeholders – too, and vice versa.
In Cameroon, our direct advocacy efforts led to regional government representatives asking the police to secure our activity sites. Elsewhere, we’ve seen regional authorities stepping in to support the movement of contraceptive products to mitigate the risk of stock outs (a risk that is higher in hard-to-move conflict environments).
4. Work with community-embedded health providers.
Why? In short: they’re already plugged into the sensitivities of their communities, thus making it easier to implement programming. We’ve learned that community providers in at-risk zones like Mali’s Mopti region should also be trained at the district level so that they can implement their learnings in the environments they know better than anyone else—their own. Moreover, in Mali, providers told us that they felt more secure in big cities, rather than their remote communities where violence is more likely to occur. Provider trainings, therefore, are held in cities.
5. Delivering youth programming… and looking to engage young people? Community-level networks can guide (or select) the picks… and weigh in on safety protocols to protect the young people we work with and for.
PSI Mali’s ProFam clinics were asked to nominate youth in their communities and confirm their nomination with local youth-led networks. Among the safety measures we emplace: we move young leaders from high-to-lower risk areas for trainings; we opt for public transportation (in Mali, public transportation is less conspicuous than an NGO vehicle that might have passengers or valuables… and therefore, an ideal target to steal) or car rentals (a more protective option in Cameroon) to get to the trainings; and stay in one place for the full five-day training, even if young leaders are from a nearby town. This has a double benefit: it both allows PSI to keep tabs on young people during the training to ensure all are safe – and keeps our groups small so, amidst COVID, we can easily adhere to social distancing protocols.
6. In conflict settings, digital platforms offer a solution to maintain engagement without having to be on-site.
Existing platforms offer effective mediums; provider supervision can be done remotely over WhatsApp (and quarterly calls). Health agents can also use WhatsApp for data collection, trainings and support. In short: use the tools available to communicate from afar.
7. If there’s one learning you takeaway, it’s this: be flexible.
Know when to say no; know how to change direction at the last minute; and know how to scrap plans and start fresh without losing sight of what matters the most: the safety of all who deliver and are served by the work we do.
Questions? Comments? Email Beth Brogaard ([email protected]).