On March 18, Knowledge SUCCESS & Family Planning 2030 (FP2030) hosted the second session in the third set of conversations in the Connecting Conversations series, One Size Does Not Fit All: Reproductive Health Services Within the Greater Health System Must Respond to Young People’s Diverse Needs. This session focused on how different service models within a health system can meet the sexual and reproductive health (SRH) needs of diverse groups of young people. Missed this session? Read the summary below or access the recordings (in English or French).
Dr. Aliou began the discussion by describing segmentation as “an approach to dividing populations or a group of people into subgroups with criteria that you identify before [starting the activity].”
As explained by Ms. Pirzadeh, the global public health sector has used segmentation on a basic level for years. She emphasized that Pathfinder International is making a strong effort to better understand the subgroups used in segmentation by looking at attitudinal and behavioral characteristics.
Mr. Gaihre shared insights from his position at the Blind Youth Association of Nepal working with young people with disabilities. He emphasized that accessibility must be an integral part of segmentation—what applies to one disability doesn’t necessarily apply to a different one.
Ms. Pirzadeh discussed how Pathfinder’s Beyond Bias Project—based in Burkina Faso, Pakistan, and Tanzania–used segmentation analysis. Pirzadeh talked about the difficulties of measuring and addressing provider bias. To mitigate this problem, Pathfinder developed and implemented a survey of providers to test key drivers of provider bias, focusing on behavioral and attitudinal characteristics. Segmentation of providers can help decision-makers prioritize interventions. Pathfinder identified six segments of providers across the three countries. Insights from the segmentation analysis helped Pathfinder determine which audience to focus on and what type of programming would be successful.
Dr. Aliou added that in Niger, Pathfinder International used the Ministry of Health’s model of segmentation at the national level. He found that segmentation improved the quality of family planning counseling when looking at the interaction between providers and clients. This approach can be helpful in determining the young people’s diverse needs in regards to SRH.
Mr. Gaihre emphasized that individuals should not forget about intersectionality when developing programs, to avoid unintentionally excluding certain groups. He discussed his work with FP2030’s Adolescents and Youth Training. In preparation for this training, his working group realized that program managers expected the same level of general SRH knowledge among deaf people and hearing people. In reality, due to a lack of SRH-specific sign language, deaf people in this context were less knowledgeable than program managers assumed. Mr. Gaihre emphasized that when developing programs, we need to make sure that we include intersectional data.
Dr. Aliou stated that Pathfinder implemented a project in which they focused on students, who are often forgotten, as they often move or have other life changes from year-to-year. Dr. Aliou found that many university students had knowledge gaps around SRH and where to look for reliable resources. Through a peer-to-peer approach, there is now a link between youth in university and youth at the broader community level—which he emphasized many programs are missing.
Mr. Gaihre described an example of a successful strategy that BYAN used: The organization visited a deaf primary school and asked the school’s teacher about their menstruation practices. BYAN was informed that the adolescents receive sanitary pads during grade six, even though their menstruation cycle can begin earlier than that. Mr. Gaihre also noted that there are fewer languages to communicate SRH for people with mental and intellectual disabilities, autism, deafness, and blindness. To respond to this, Mr Gaihre stated that early intervention is the best approach: “We can’t wait until she gets her first period to teach her how to use the sanitary pad. That intervention would be too late.” Mr.Gailhre also emphasized that when providers lack certain skills to communicate with deaf individuals, sign language interpreters are invited to develop different signs for SRH terminology.
Ms. Pirzadeh discussed Thinking Outside the Separate Space, a contextual decision-making tool developed by Pathfinder International’s Evidence to Action (E2A) Project, to guide program designers in selecting appropriate youth-friendly service delivery models. This tool allows decision-makers to look beyond the most common approach of using a separate space to reach young people. Program designers can walk through a seven-step process to best align their selected program model to their context, helping programmers get closer to identifying young people’s diverse needs.
Ms. Pirzadeh emphasized that in some ways, scale and segmentation are opposing forces. It is important to determine the usefulness of segmentation before undertaking analysis. Ms. Pirzadeh stressed that scaling-up can be difficult when looking at one specific community, but is more feasible when looking across countries. Dr. Aliou added that in deciding between the use of scaling-up or segmentation in Niger, it depends on the context, especially when looking at Pathfinder International’s Impact program. Mr. Gaihre emphasized that scaling-up and segmentation are equally important when developing programs to help adolescents.
A participant during the conversation shared a useful guidance tool related to scale in the chatbox: Beginning with the End in Mind: Planning Pilot Projects and Other Programmatic Research for Successful Scaling Up.
The discussion concluded with a question about the impact of COVID-19 on outreach to various individuals. Mr. Gaihre commented that most of the institutions that were providing support to individuals with disabilities were shut down. As a result, this community was forced to return to places that didn’t necessarily have the skills and technology training to meet their needs. BYAN provided resources for this community in various formats to address accessibility. Ms. Pirzadeh emphasized that women and girls bear the brunt of COVID-19’s secondary impact—for example, restricted movement and isolation. Specifically looking at Pakistan—where women health workers have mobility restrictions, increased COVID-19 exposure risk (due to lack of personal protective equipment), and more—Pathfinder International was forced to examine gender-sensitive responses and integrate SRH into COVID-19 content.
“Connecting Conversations” is a series tailored specifically for youth leaders and young people, hosted by FP2030 and Knowledge SUCCESS. Featuring 5 modules, with 4-5 conversations per module, this series presents a comprehensive look at Adolescent and Youth Reproductive Health (AYRH) topics including Adolescent and Youth Development; Measurement and Evaluation of AYRH Programs; Meaningful Youth Engagement; Advancing Integrated Care for Youth; and the 4 Ps of influential players in AYRH. If you’ve attended any of the sessions, then you know these are not your typical webinars. These interactive conversations feature key speakers and encourage open dialogue. Participants are encouraged to submit questions before and during the conversations.
Our third series, One Size Does Not Fit All: Reproductive Health Services Within the Greater Health System Must Respond to Young People’s Diverse Needs, began on March 4, 2021, and will consist of four sessions. The remaining two sessions will be held on April 8 (What does it look like to implement an adolescent responsive approach?) and April 29 (How can our health systems serve adolescents as they grow and change?). We hope you’ll join us!
Our first series, which ran from July 15 through September 9, 2020, focused on a foundational understanding of adolescent development and health. Our second series, which ran from November 4 through December 18, 2020, focused on critical influencers to improve young people’s reproductive health. You can watch recordings (available in English and French) and read conversation summaries to catch up.