Four Pathfinder International country representatives talk about how E2A has helped to make interventions in their countries scalable

On Monday, October 3, four Pathfinder International country representatives—from Democratic Republic of the Congo (DRC), Ethiopia, Niger, and Nigeria—told an audience at the Kaiser Family Foundation, in Washington, DC, how E2A-supported interventions in their countries were designed to make scaling them up feasible. The interventions are ones that expand contraceptive choice for underserved populations of women, adolescents, and youth in contexts where there is a high unmet need for family planning services. 

Aben Ngay of the DRC described an E2A-supported community-based family planning program, which has significantly increased rural populations’ access to family planning services in three southern provinces. “Family planning services were primarily facility based, and as you know, no one goes to the facility get family planning in the rural areas where we work,” he said.

E2A is now working on a plan to scale up this community-based family planning program to additional health areas in the three provinces.  E2A is working closely with local and government stakeholders and has been using  ExpandNet’s tool Beginning with the end in mind to design and implement the project.

“We cannot insist enough on participation from all levels to design the project,” said Ngay.

Farouk Jega of Nigeria presented a study in Kaduna and Cross River states, Nigeria, which has examined the safety and effectiveness of training Community Health Extension Workers (CHEWs) to administer implants at health facilities. The study follows the passage of a federal task-sharing policy in 2013, which allows a wider provider base, including CHEWs, to provide a variety of maternal, newborn, and child health services   including long-acting reversible contraceptives (LARCs). The study is meant to provide a strong evidence base that will encourage other Nigerian states to operationalize the recent policy and allow CHEWs to provide LARCs.

“We do have some evidence, although very preliminary, for scale-up,” said Jega. “We plan to use the ExpandNet systematic approach to involve all stakeholders at the state and national level to plan for scale-up.”

Mengistu Asnake described another E2A-supported study, in Ethiopia, which has built evidence around expanding contraceptive choice for youth to include LARCs. The approach tested involved training youth-friendly service providers to provide LARCs at the same time as they provide youth other services, training peer educators to counsel on and refer for LARCs, and providing ongoing supportive supervision. Using compelling evidence from the study, the Integrated Family Health Program+, which supports all of the sites involved in the study, in collaboration with Regional Health Bureaus, has already scaled the trainings to an additional 76 sites beyond the initial 10 intervention and 10 nonintervention sites. 

“Currently, we have reached almost 50 percent of youth-friendly service sites to provide LARCs and the expansion will continue,” said Asnake.

Presenting E2A’s University Leadership for Change (ULC) Project, Sani Aliou of Niger talked about the comprehensive behavior change approach applied by the project as well as how the project strengthened sexual and reproductive health services at Abdou Moumouni University in Niamey, and put measures in place for stakeholder engagement and sustainability. 

“The project set up a steering committee composed of student leaders, university management, Ministry of Health, and Ministry of Education that sits together to review and monitor the implementation of the intervention,” said Aliou.

The design and documentation of ULC was guided by Beginning with the end mind. E2A documented the pilot project in Niamey as well as the testing of the interventions at three additional campuses at Niger. Evidence from that documentation process is feeding into a scale-up plan that will expand the ULC interventions to the three additional campuses in Niger.

In addition to the country representatives, Rita Badiani, E2A Project’s Director gave opening remarks. Patricia McDonald, Senior Technical Advisor at USAID’s Office of Population and Reproductive Health and AOR for the E2A Project, and Teshome Woldemedhin, a Global Health Fellow at USAID and Senior Youth and Sexual and Reproductive Health Advisor for the Office of Population and Reproductive Health, moderated the discussions.

To listen to a full recording of the event, please click here.

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