Bringing Youth-Friendly Services to Scale in Ethiopia

This technical brief analyses the efforts of the Ethiopian Federal Ministry of Health (FMOH) and Pathfinder International's efforts to introduce and scale-up youth-friendly services (YFS) in the Ethiopian public health system in order to address the barriers that stigma, service costs, and provider bias pose to Ethiopian young people's ability to access sexual and reproductive health (SRH) services. The efforts included the strategy to pilot and sustainably scale YFS by emphasising both institutionalisation (vertical scale) and geographic expansion (horizontal scale). Pathfinder leveraged two consecutive integrated family planning and reproductive health programmes to lead and support this effort. This project, the Integrated Family Health Project (IFHP), is led by Pathfinder International and John Snow, Inc. in partnership with the Consortium of Reproductive Health Associations (COHRA) and 11 other local
implementing partners.

One important step to gain buy-in from Ethiopian government ministries, reproductive health-focused civil society partners, and youth associations was to visit the Geracoa Biz programme in Mozambique to witness a successful YFS programme at scale. The FMOH and Pathfinder, together with selected pilot sites, held a series of regional consensus workshops and participatory site assessments with staff, health officials, health facility providers, young people, and project staff to identify gaps and lead to the development of facility-level action plans for YFS. Trainings were held for health providers and volunteer YFS-supporting peer educators (PEs). YFS implementation included community engagement activities to reduce stigma and discrimination. Quarterly reviews helped to troubleshoot challenges and design tailored responses, all documented to form the basis for the intervention's YFS scale-up plan.

The analysis of the scale-up trajectory was done in comparison/alignment with ExpandNet and World Health Organization (WHO) guidance. [ExpandNet is a global network of representatives from international organisations, non-governmental organisations, academic and research institutions, ministries of health, and specific projects who seek to advance the science and practice of scaling up.] From 2008 to 2012, communication-related scale-up activities included:

• Releasing a national YFS curriculum and plan agreed to across partners.
• Holding learning exchanges at model pilot sites.
• Testing of the new Ethiopian national YFS tools. During the implementation process, partners collaboratively conducted ongoing monitoring, site visits, and continuous quality improvement.

One lesson learned was that age-disaggregated data play a key role in a programmes' ability to design and maintain YFS that are responsive to local contexts. Once tools were provided for collecting this type of refined data, partners trained FMOH staff to disaggregate data for family planning services, abortion-related services, and voluntary counselling and testing for HIV.

In order to secure resources for YFS, IFHP employed a strategy of cultivating Regional Health Bureaus and woreda (district) leaders and health facility managers to help gain buy-in and, hence, financial and logistical commitments to YFS. This issue of resources is often resolved through collaboration of facility management committees and community- and health system-based YFS champions.