Meet EngenderHealth’s Chief of Party for AgirPF

Tell us about your background and how you got into this field of work.

I am an obstetrician/gynecologist with over 33 years of public health experience providing technical leadership and managing family planning (FP) and reproductive health (RH) projects.

I have worked in more than 15 African countries (including Togo, Benin, Burkina Faso, Chad, Côte d’Ivoire, Mali, Madagascar, Niger, Cameroon, Kenya, and Senegal) for long-term assignments and providing technical assistance. This provided me with in-depth knowledge of FP and RH in Sub-Saharan Africa. I have extensive experience working with multilateral agencies such as the United Nations Population Fund and the World Bank, as well as nongovernmental organizations (NGOs) such as Jhpiego, IntraHealth International, GIZ, the International Planned Parenthood Federation Africa Region affiliates, etc. I am fluent in French, English, and Mooré.

What is your role at EngenderHealth?

I was the former Technical Director and Deputy Chief of Party. I am the newly appointed Chief of Party. My role at EngenderHealth is threefold: setting the AgirPF vision, strategy, and project deliverables; taking overall programmatic, managerial, and fiscal responsibility for the project, including ensuring compliance with USAID and EngenderHealth regulations, policies, and procedures; and managing internal relationships with project staff and external relationships with USAID, headquarters, partners, and other key stakeholders and donors. 

What is the AgirPF project and what are its main objectives? Whom does the project serve?

Everyone knows that Francophone West African countries are facing two main challenges: high fertility rates, resulting in rapid growth of its population, and an unacceptable mortality rates, both for mothers and children.

AgirPF’s purpose is to enable people to make voluntary and informed decisions about contraceptive use. It aims to increase access to, quality of, and demand for FP in five countries—Burkina Faso, Côte d’Ivoire, Mauritania, Niger, and Togo—collaboratively with ministries of health and other local partners.

What have been the successes of the project thus far?

EngenderHealth built AgirPF based on its Supply–Enabling Environment–Demand (SEED) Programming Model, and the project has to fulfill a triple role:

–     Supply: increasing access to quality FP services and information. Some successes include: All of the 264 AgirPF implementing sites are now providing both short-acting contraceptives and long-acting reversible contraceptives; high-impact practices such as integration of FP into maternal and child health care services, including at immunization points, have been successfully introduced; and FP special days have provided free FP services to women.

–     Demand: Regional and country-specific social and behavior change communication (SBCC) strategies are in place and campaigns have been launched to provide evidence-based information to populations. These will inspire people to seek FP services

–     Enabling environment: AgirPF has been instrumental in improving the sociocultural and religious climate for FP. Thanks to AgirPF, Burkina Faso, Côte d’Ivoire, and Togo have established a budget line for FP in their national budgets. Mauritania has adopted its RH Law (for the first time), and Côte d’Ivoire is finalizing its RH Law.

Why is it important to expand access to FP and broaden voluntary use?

Expanding access to FP services is the best investment a country can make for its population. FP offers many benefits for individuals, families, and society. Every year, in the AgirPF implementing countries, for every 100,000 live births, about 400 women die of problems from pregnancy, childbirth, and unsafe abortion. FP could have prevented most of these deaths. Therefore, enabling women to make voluntary informed decisions about FP reduces unintended pregnancies as well as maternal and newborn deaths. It also increases educational and economic opportunities for women and leads to healthier families and communities.

What have been major challenges along the way? How does EngenderHealth address them?

The major challenges AgirPF is facing are:

• Structural barriers: Providers are not sufficiently skilled to avoid medical barriers that affect the demand for FP services, such as poor quality of or access to services, policy barriers, inequitable gender norms, lack of social support, and deeply rooted attitudes that lead many with an unmet need to refuse to use FP. To address these problems, AgirPF has trained at least 1,200 providers and regularly supervises them so they offer FP-friendly services, following a rights-based approach (ensuring voluntary and informed choice). AgirPF is rolling out SBCC campaigns in each implementing country to spread rights-based information about FP and is organizing site walk-throughs for local leaders to engage them in promoting FP in their influence areas.
• Sociocultural and religious barriers: The environment is rarely enabling, with inhibiting policies, guidelines, practices, and gender barriers. For instance, in Niger and Mauritania, contraceptive use is only acceptable for married women; for some unmarried women, using contraceptives is considered a sin. AgirPF is applying its advocacy strategy to reduce such barriers by training local, traditional, and religious leaders about FP and its advantages. AgirPF also uses local NGOs, parliamentarians, and governments to change policies, rules, and regulations to enable the FP environment.
• Political and social instability: AgirPF project implementation is also affected by political and social problems.

Do you have a story you would like to share involving your time with the project thus far?

One day, I realized the extent to which AgirPF’s work is important for women. In Côte d’Ivoire, during an FP special days event (FP special days are days dedicated to free FP service provision, especially for underserved and hard-to-reach people), a mother of six said, “Thanks EngenderHealth, I am relieved. I sought a contraceptive method for long time but I could not pay for it, and today, I have it and free! I am saved….”

When you hear such confessions, you realize that what you are doing is not enough and that you need to do much more, and this is exciting!

How do cultural barriers and gender affect unmet need and quality of care?

In some instances, where it is culturally unacceptable for girls and women to access FP services, providers are quick to deny FP services to clients. We often hear remarks such as “At your age, you want to use contraceptives? Why?” or “Are you married? Does your husband agree to your using contraceptives?” and so on and so forth. Elsewhere, women are pressure to have several children. In such situations, providers do not have the needed experience to provide quality services; in the same vein, women and girls are not sufficiently exposed to FP information and services, and demand and supply sides suffer, resulting in increased unmet need for FP.

Is there anything else you would like to add or share on the project or its future?

We should bear in mind that we are the catalysts of change only. The communities in which we are working are the ones who can solve FP/RH issues. They need us to help with relevant information and capacity building. Then they will engage and drastically change sociocultural norms to advance. Let us double our efforts and change the way in which we are doing things. We cannot always do things in the same way and wait for substantial change.

For AgirPF’s future, there is no miracle. We have to work hard to achieve our results.