Introduction
Methods
Study area
Study design and study population
Sampling technique
Data collection
Data analysis
Stakeholder potentials
Stakeholder positions
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Savior. This is addressed to those with strong power, supportive attitude and active interest in adolescent SRH program. The parties will do whatever is necessary to maintain their position and try to attend to adolescent SRH needs.
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Friend. Refers to those with weak power, supportive attitude and active interest in the adolescent SRH program. They should be positioned as advisers.
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Sleeping giant. This refers to those with supportive attitude, strong power and passive interest in adolescent SRH program. In order to be awakened, this category of people should be included in the process.
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Acquaintance. This refers to those with supportive attitude, weak power and passive interest in adolescent SRH program. This category of stakeholders should be kept in touch, communicated and provided with continuous information.
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Saboteurs are those stakeholders with non-supportive attitude, strong power and active interest.
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Trip wire refers to those who have non-supportive attitude, weak power and passive interest in adolescent SRH programs. They need to be understood, so that they can be carefully approached.
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Irritants are those with non-supportive attitude, weak power and active interest in adolescent SRH programs.
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Time-bomb refers to stakeholders with non-supportive attitude, strong power and passive interest in the adolescent SRH program.
Results
KII and FGD participants’ profile
State-level policy/decision makers’ mapping based on their perceptions of their influence, attitude and interest in ASRH
Public institutions /NGOs | Policy advocacy and policy development | Program implementation and service delivery | Technical support and capacity building | |
---|---|---|---|---|
State primary healthcare development agency (SPHCDA) | Power | – | + | + |
Attitude | – | + | + | |
Interest | - TRIP WIRE | + SAVIOR | + SAVIOR | |
SMOH (Public Health; Reproductive health unit; Gender; School health; Family planning; Social mobilization) | Power | + | + | + |
Attitude | + | + | + | |
Interest | + SAVIOR | + SAVIOR | + SAVIOR | |
DPRS (Dept. of Planning, Research and Statistics) | Power | + | – | – |
Attitude | + | – | – | |
Interest | - SLEEPING GIANT | - TRIP WIRE | - TRIP WIRE | |
SMOE (Education Service dept.; School Service unit) | Power | + | + | – |
Attitude | – | + | + | |
Interest | - TIME BOMB | + SAVIOR | + FRIEND | |
ESUBEB (Ebonyi State Universal Basic Education Board) | Power | – | + | – |
Attitude | – | + | – | |
Interest | - TRIP WIRE | + SAVIOR | - TRIP WIRE | |
Ministry of Women Affairs and Social Development (Gender unit; Social welfare unit) | Power | – | + | – |
Attitude | + | + | + | |
Interest | - ACQUAINTANCE | + SAVIOR | + FRIEND | |
Ebonyi State Ministry of Youths and Sports | Power | – | – | – |
Attitude | – | + | + | |
Interest | - TRIP WIRE | + FRIEND | + FRIEND | |
Ebonyi State House of Assembly (State Legislature) | Power | + | – | – |
Attitude | – | – | – | |
Interest | + SABOTEUR | - TRIP WIRE | - TRIP WIRE | |
Institute of Child Health, FETHA | Power | – | + | – |
Attitude | – | – | – | |
Interest | - TRIP WIRE | + SABOTEUR | + IRRITANT | |
NGOs (AMURT; JHPEIGO; Safe Motherhood Ladies; Health Policy Plus; BAN) | Power | – | + | + |
Attitude | + | + | + | |
Interest | + FRIEND | + SAVIOR | + SAVIOR |
Policy advocacy and development
“Policies guide the activities of people practicing in the State. We follow the national guidelines and modified as necessary. We develop some policy documents; there is one we are just working on, it is not yet finalized.” (SPM02-male _Public health department SMOH).
“We are involved in developing annual work plan targeting adolescents and this is what guides us for the year. We use the 2006 School Health Policy.” (SPM08-Fmale _School health unit SMOH).
“[I] was involved in the roll-out of minimum care package for adolescent SRH as highlighted in the Adolescent SRH policy [of] 2007 … All [ …] desk officers from the whole 36 states including FCT participated...” (SPM05-Female _reproductive health unit SMOH).
“...Strategic plans of all the activities in the ministry are embedded in our own strategic plan. So, adolescents’ [health] is well captured there.” (SPM03-Male_budget and planning).
“Our organization does not formulate policies, though the organization was part of the development at the beginning stages; and we also align with the national policy on adolescent SRH.” (SPM23-Female _NGO).
“[My] organization is not really or directly involved in policy formulation. Indirectly, we have been invited to planning meetings at the State Ministry of Health and by partners. I will say a little because we do not have the power to formulate policies except, we are called to be part of it. But, we also look out for times when we will be invited to fully participate in developing policies on adolescent SRH” (SPM20-Female _NGO).
Program implementation and service delivery
“Every year we incorporate adolescent SRH into our programs, and create strategic plan. Our involvement is mostly in sensitization. We are social welfare people, we render social services, counseling, psychosocial duties and referrals. For instance, if a girl becomes pregnant, it is a problem. We emphasize the need for the girl child to have information on how to prevent rape and STI. We go to schools and sensitize them on female genital mutilation (a health factor) which is rampant in Ebonyi State.” (SPM17-Female_Ministry of women affairs).
“The reproductive health unit of the Ministry of Health is doing well as it concerns our mothers, children and even adolescents because in that unit, we have family planning as one of the components and adolescents require family planning which is the contraception we are talking about. So, the Ministry of Health is assisting in that area to ensure that the adolescents receive this contraception.” (SPM05-Female _reproductive health unit SMOH).
“We go on family planning sensitization. We also go on advocacy visits to the opinion leaders in the community because they are highly regarded in the society. We educate them on the implications of teenage pregnancy; that when a teenage girl has so many children, it poses a lot of challenges to the society” (SPM09-Female_social mobilization unit SMOH).
“We have service delivery partners who provide commodities. Our target is to change the social norms of child spacing, by engaging the traditional leaders, community leaders and the religious [leaders] to address barriers to contraception through communication tools that we developed. We identify upstanding members of the community and use them to reach out to the members of a community.” (SPM 21- Female _NGO).
“The Primary Health Care Development Agency is fully involved in adolescents’ reproductive health in the sense that we have created a budget line for procuring contraceptives and these contraceptives have been procured. They will be made available to the adolescents to prevent unwanted pregnancies and sexually transmitted diseases. In fact, to tell you how important it is, we have focal person that is responsible for reproductive issues, we call them sexual and reproductive health focal person. So, it is a very big priority to the agency.” (SPM01-Male_SPHCDA).
“Safe motherhood [initiative] created a youth center where adolescents are invited sometimes with their parents for sensitization programs.” (SPM23 female, Safe Motherhood Ladies Association).
“[We have] a drop-in center for out-of-school adolescents to access information on SRH while acquiring vocational skills” (SPM16_ Women Affairs and Social Development).
Technical support and capacity building
“The Ministry of Health also builds the capacity of these adolescents by organizing trainings for them to pass this information concerning them. All these issues we have enumerated, issues about STI, issues about contraception, issues about malaria and so many other programs. So, they organize trainings for them, both for their providers and for the adolescents themselves.” (SPM05-Female _reproductive health unit SMOH).
“The Ministry has trained over 80% of their health workers on adolescent health” (SPM08- Female _school health unit SMOH).
“Well, we have supported the State to strengthen the adolescents’ sexual [and] reproductive health. We also work closely with the Ministry of Health, the adolescent focal person and desk officer. We work closely with her and her team in all these things I have said” (SPM 24- Female _NGO).
“[We] collaborated with MOH, UNICEF and UNFPA in training teachers and peer educators on how to provide SRH information to students” (SPM 12- Female _SMOE).
“In collaboration with the media house, they [media] send out jingles [to] sensitize parents, communities [and] adolescents, and [to] inform the public [of] where they can access adolescent counseling services” (SPM 15-Female_Ministry of Women Affairs).
Local government decision makers’ and community leaders’ mapping based on their perceptions of their influence, attitude and interest in ASRH
LGA/Community influencers and Service Providers | Policy advocacy and development | Program implementation | Engagement with local authorities and organizations | |
---|---|---|---|---|
Traditional Rulers and Village Heads | Power | – | + | + |
Attitude | + | – | + | |
Interest | + FRIEND | + SABOTEUR | + SAVIOR | |
Religious organizations and leaders | Power | – | + | + |
Attitude | – | + | – | |
Interest | - TRIP WIRE | - SLEEPING GIANT | + SABOTEUR | |
Adolescent and reproductive health focal persons (LGA) | Power | – | + | – |
Attitude | – | + | + | |
Interest | - TRIP WIRE | + SAVIOR | + FRIEND | |
Public Secondary Schools (Principals & Guardian counsellors) | Power | – | + | – |
Attitude | + | + | + | |
Interest | - ACQUAINTANCE | + SAVIOR | + FRIEND | |
Town Union and Ward Development Chairmen | Power | – | – | + |
Attitude | – | + | + | |
Interest | - TRIP WIRE | + FRIEND | + SAVIOR | |
LGA Administrative Secretaries | Power | – | + | – |
Attitude | + | + | + | |
Interest | + FRIEND | + SAVIOR | + FRIEND |
Policy advocacy and development
“I would have liked it if I am called to be part of the policy [development for adolescent SRH] ... We used to have a program where we go to develop the policy that will be guiding reproductive health [programming] in the State... From the national policy, we develop the state policy. [And] from the state policy we develop the local government policy. It is the backbone from where we step down to the communities … “(IIK01- Male_ administrative secretary).
“[I am] not part of it [policy development for adolescent SRH]. But, in our community, we made a law that if you impregnate a girl, you will marry her. But if you say you will not marry then you will have to stay with the person until she delivers the baby and the baby starts walking then you can let her go. You will take care of the girl [adolescent] and the baby. And you, the male, after going through the suffering it will be better for you to marry her. That is the law of the community and in having this type of policy the Igwes [traditional rulers] should be called to say their mind.” (VHEZ- Male_ village head).
“We generate the information and give to them for developing [policy]; though information goes two ways – it is either from the top to down or down to top. Initially, there is nothing like sex education in secondary schools. We then discovered with AIDS and all what not, that it is necessary to inculcate [sex education] in the scheme of work. We now prepared the scheme of work and sent to government; government approved it and returned to us to implement” (IIZ01- Male_ school principal).
Program implementation and service delivery
“...We have the office of the guidance counselor and students go and they talk privately. We also do sex education through the guidance counselor or health personnel that visit the school. We provide information on reproductive health system, secondary sexual characteristics of boys and girls, puberty and others” (IEZ01-Male_School principal).
“...Yes, as the health department in [the] LGA, we embark on sensitization program for adolescents in schools, and in health facilities. On our outreach days, we call on teenagers [and] their parents and educate them on what they should be doing. We do this every Tuesday; and also during immunization, we give health talks on adolescent sexual and reproductive health for teenage mothers to benefit. Also, we do carry out a special information campaign on adolescent SRH with people within the age of 15 to 49 for healthy living” (IOH04-Female_LGA focal person on adolescent SRH).
“We have the youth organ in the church; and as a teacher, once in a while we make arrangements for them to have some kind of seminar where we teach them about being young people and growing into adulthood. And in such seminars and retreats, they are being exposed to things they need to know about their sexuality.” (IIZ02-Male catholic religious leader).
“Here also, in the school, all of them are adolescents. So, we find time and teach them out of class. As I told you, the [guidance] and counseling (G&C) teacher is transferred almost every section, and a new person is posted to the school. The G&C will take care of the student by guiding and counseling them on adolescent SRH. It is through this [guidance] and counseling that you will know the problem of individual students. Occasionally, we give them talks on reproductive health. Like every Friday, we have social gathering and we channel it [the talk] on reproductive health so that they [students] will know the dos and don’ts” (IIZ01- Male_ School principal).
“We employ some experts, recruit and train some people and post them to different places where we provide those (SRH) services” (IIK01- Male_ administrative secretary).
“We have been receiving some NGOs. Some health worker have been coming to educate students mostly on Thursdays when we usually have our moral instructions. We do welcome some of them when they come to educate the students. We also appreciate their efforts because they are helping us to do our work” (IAB02- Female_ School principal).
Engagement with local authorities and organizations
“At the beginning of a new session, we organize an event called, “come and hear“. It is a time the villagers come to hear what the school intends to do about the SRH issues, such as teenage pregnancy, that affect the girl child. We carry everybody along. So, before the event, we meet with relevant authorities in the village and engage with them.” (IIZ01-Male_principal).
“...we engage community mobilization officers, and the traditional institutions in order to mobilize people and educate them.” (IIK01-Male_Admin sec., LG Health Department).