Presentation_Mekuria, Derni - Catalyzing Investments in RMNCAH at the Community Level
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CORE Group Global Health Practitioner Conference 2019
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Presentation_Mekuria, Derni - Catalyzing Investments in RMNCAH at the Community Level
- 1. The TESFA Model: Our path to scaling an integrated ASRH program Feven Mekuria, MD MPH Ryan Derni, MPH May 9, 2019
- 3. TESFA – Background • TESFA means ‘Hope’ • Married girls fall through the programming cracks! • Ever-married adolescent girls below 18 and Community influencers/social gatekeepers • Launched in 2010; adapted for and informed ASRH programs • Scale up - currently underway May 15, 2019 3 Addis Ababa (Capital City)
- 4. TESFA Model SRH Core Components • Peer-delivered SRH curriculum, including training on communication and negotiation skills Economic Empowerment (EE) Core Components • Peer-delivered training on financial literacy and management based on Village Savings and Loans Association model • Group-based savings • Income generating activities (IGA) Base Program Components • Peer solidarity groups • Bi-monthly meetings Community Engagement • Community groups of key stakeholders and gatekeepers • Social Analysis & Action dialogues • Community champions for adolescents’ SRH and EE
- 5. 29%↑ in health facility visits (10% control) Changed social norms: ↑ joint decision making, ↓ of GBV and early marriage 72%↑ savings of their own (12% control)1 100% of groups surveyed (196) continued meeting after the end of the project2 TESFA Results 4 years after implementation, the TESFA model had both been sustained and replicated to reach more girls! 1TESFA End line results, 2013 – Randomized Control Study 2 TESFA ex-post evaluation – after 4 years, 2017 (5% control)
- 6. TESFA In Practice: Mikre’s Story
- 7. TESFA+: Beyond Business as Usual • TESFA+ harnesses 7 years of implementation to design and test a more impactful and scalable version of the TESFA model • We are currently doing this through formative research and co-design with the girls, communities, and partners • This will result in a TESFA+ model that CARE will then implement and test over 2.5 years in Ethiopia – expanding learning and program to other 7 countries.
- 8. TESFA+: Four Phases for Graduating Impact May 15, 2019 8 Learn from girls and communities: • What are the essential elements of success? • What facilitates self-replication? • How can we enhance the model? Amplify successful components and test new prototypes developed by adolescent girls themselves Develop a robust design, including Theory of Change and comprehensive learning components Provide proof of effectiveness – both evidence on if the TESFA+ model self- replicated; as well as if it impacted key SRH and economic empowerment outcomes.
- 9. Phase I - Formative Research Approach TESFA+ Scale Up InvestigationTESFA+ Investigative Research Conducted with who? Why? • Peer orgs • Gov’t stakeholders • Partner orgs Glean how to handover the model and implement it at scale Conducted with who? Why? • TESFA Girls • Husbands • Community groups Glean how to enhance the model to make it more sustainable and scalable Findings and insights to inform the design and handover of TESFA+
- 10. Phase II - Human Centered Design (HCD) Approach New Model & Prototypes Design Insights Gov’t How might we questions Journey Maps Design Insights SAA How might we questions Journey Maps Design Insights Girls How might we questions Journey Maps Designing the Solution with End Users: Primary HCD Methods Used “How Might We….?” We used this method to reframe our problems as opportunities by writing and answering “how might we questions”. E.g., How might we encourage TESFA girls to create and lead new groups? Journey Mapping This method compiles a series of user goals and actions into a timeline skeleton around a persona to flesh out user thoughts and emotions to create a narrative and generate design insights. E.g., Journey map of Helen, a graduated TESFA member, starting a new TESFA group Insights from HMW questions inform journey maps HCD cascade approach to design the new model and prototypes
- 11. Successful components: • VSLA – EE key motivator for sustainability and replication. • Value for solidarity and friendship through girls’ groups • TESFA girls recognized as role models in the community • Support from husbands and community/SAA groups. • Integrated program – addressing multiple needs of girls – push for collaboration across sectors New prototypes: • Graduation/recognizing old TESFA girls/women – as mentors for new girls groups. Role model approach – story telling and roleplaying • Rebranding SAA and developing marketing strategy - government uptake. Develop an accreditation or license approach for SAA facilitators • Targeting scalers as end users –TESFA Facebook success story exchange targeting gov’t workers • Religious institutions against child marriage Phase II – Co-design Insights
- 12. • Phase II – Amplify successful components and test new prototypes developed by adolescent girls themselves • Phase III - Develop a robust design, including Theory of Change and comprehensive learning components • Phase IV: Provide proof of effectiveness - Launch a research- based TESFA+ model and test effectiveness. Next steps for TESFA+ May 15, 2019 12
- 14. Resources TESFA model brief - http://www.care.org/sites/defa ult/files/tesfa_2_pager_screen. pdf TESFA+ Investigtaive Research Summary - https://www.care.org/sites/def ault/files/letter_tesfainvestigati veresearchbrief_screen.pdf TESFA evaluation: summary of the evidence by ICRW - http://www.care.org/sites/defa ult/files/documents/TESFA%20F inal%20Evaluation.pdf TESFA ex-post evaluation (brief and full report) - http://www.care.org/sites/defa ult/files/tesfa_ex- post_final_report_sept- 2017.pdf Points of Contact: Feven Mekuria, Feventassaw.Mekuria@care.org; Ryan Derni, Ryan.Derni@care.org
- 15. Group Discussion Palladium 1. Are there any real life examples of where you’ve used SDGs framing for advocacy? 2. Could the FP-SDGs model be applied/leveraged in any countries in which you work? 3. How could the FP-SDGs model be improved in order to speak to the interests of decision-makers in your geographies? TESFA 1. What are best practices and approaches when facilitating a government handover of an intervention? 2. What are ways to maintain the quality and core components of an intervention that replicates on its own? Optional • Tips of scaling multisectoral/integrated programming – what are the entry points or platforms?
Hinweis der Redaktion
- We have about 7 years of implementation experience
- With this background and in an effort to address the multiple challenges, the TESFA model was designed with two main components Girls – peer based solidarity groups are built (14-19 year olds)--- to receive not only the Village Savings and Loan Association but also age and context appropriate SRH, life skills training, issues related to Gender Based Violence and IGA. ++++++Safe spaces …. On the other hand, the Community engagement with gatekeepers – was guided by the Social analysis and action model (SAA for critical reflection, dialogue and community action) [The community group sessions were facilitated by elected community members and focusing on gender and social norms that drive both child marriage and the challenges faced by married girls.] ++++++social support …. Curriculums – Girls (VSLA, SRH, Life skills) and community (SAA – for critical reflection and action) – with a 12 months cycle per each group Timeline – 12 months – phase in and phase out
- families and communities joint action – joint decision making, reduction of GBV and early marriage more girls had savings of their own (compared to 12% in control)1
- https://youtu.be/iYXBdLF4NPQ
- So with these findings and insights the TESFA+ initiative is designed and launched to design and test A SCALABLE AND MORE IMPACTFUL
- There were a series of three back to back workshops with original TESFA girls, SAA participants and government stakeholders that followed a progressive format by which each workshop used human centered design approaches to identify design insights. These design insights informed the human centered design approach for the following workshop participants so that by the end of the workshop we had identified the main elements of the new TESFA model and the prototypes. We conducted many participatory exercises for the co-design process, but the main two human centered design approaches we used were how might we questions and journey maps. How Might We Questions We used this method to reframe our problems as opportunities by writing and answering “how might we questions”. Our problems and questions were informed by the findings from Phase I formative research. E.g., How might we encourage TESFA girls to create and lead new groups? Journey Mapping This method compiles a series of user goals and actions into a timeline skeleton around a persona to flesh out user thoughts and emotions to create a narrative and generate design insights. E.g., Journey map of Helen, a graduated TESFA member, starting a new TESFA group
- Using Human Centered design, in close collaboration with the innovations team, co-design workshop was conducted with girls, community groups and government partners Co-design workshop - Phase II – to help Amplify successful components and test new prototypes Visible changes in participants lives – motivation for others to join + Huge demand to share their stories with others and support others Girls’ interest to be formally recognized and support other younger girls Active engagement of community groups to support TESFA girls Integrated program – attracts the attention of multiple sector offices of the government – push for collaboration across sectors Religious institutions teach against child marriage – develop a manual with reference to scripture
- Some of the ideas so far….. Role model approach for girls – TESFA girls want to be role models/mentors for other girls Story telling and experience sharing – TESFA girls are excited to share their journey and experiences with others Use of Media/communication platforms – to amplify the voice, stories, successes and learnings across the region/country Networking across girls groups, links with WDAs and other existing groups and structures ….. ****Our hypothesis is that social capital acts as a kind of social ‘bank’ that is accumulated over time and from which people are drawing, in order to take social risks – like delaying marriage. We think this may therefore be a critical component of the model and lever for sustainable and scalable change!!! *****We’re excited to explore the power of social capital and connectivity between girls. (listening to girls, what and how they want this program to be to better serve their aspirations)!!! - girls have requested further, inter-group connectivity.)
- Highlight the concept note