Supporting a Project for the Promotion of Women’s Health in Burkina Faso

Project location: Burkina Faso, Ouagadougou
Project start date: June 2012 - Project end date: May 2013
Project number: 2012-048
Beneficiary: AIDOS

According to the Human Development Index (HDI 2011), Burkina Faso is at the 181 place out of 187 countries. Burkina Faso has a population of 17 million inhabitants and an annual growth rate of 3%. 55.75% of the population is composed of young people aged between 0 and 18 years and of these 49.5% is younger than 15 years. In Burkina Faso 57% of the population live with less than 1.25$ a day, life expectancy is 55 years for men and 57 for women and the illiteracy rate is among the highest in the world, equal to 53% for men and to 67% for women. The Country is still far from the attainment of the Millennium Development Goals, above all: Eradicate extreme poverty and hunger (Goal 1), Promote gender equality and empower women (Goal 3), Reduce child mortality (Goal 4) and Improve maternal health (Goal 5). The maternal mortality rate, 560 deaths out of 100.000 delivers, is among the highest of the region and the child mortality rate out of a thousand born alive is 166.4 (on a world average of 61.7). The majority of these women's life could be saved with pre-natal care. The maternity rate among adolescents is 131 out of 1,000 girls of 15-19 years (on a world average of 49). The diffusion of modern contraception methods is very low, equal to 13%. The Burkinabe society is characterized by a widespread patriarchy and by a very low value attributed to women and their role in the community. The inequality between women and men lead to consider as "normal" actions of domestic violence, abuses, subjugation of girls and women to harmful traditional practices such as early and forced marriages, female genital mutilations/cutting (FGM/C), widows' marginalization, etc. FGM/C still remains widespread, with a 77% prevalence rate (DHS 2003), despite the political will to promote its abandonment through a law in force since 1996 that punishes the practice.
Adolescents represent more than 50% of the Burkinabe society. Adolescent girls are submitted to many restrictions, such as: the access to education and basic health services, the access to resources, the employment in the formal sector. The majority of them is forced to get married when they are still under-age (despite the law establishes that 17 years is the minimum age to get married) and more than 1/3 are obliged to live within a polygamy union as second or third wife of a man much older than they. Usually these young women have a child in the first 20 months of their marriage. The almost non-existent access to health services puts Hiv/Aids prevention and treatment out of women's reach.
The project is located in Sector 27 of the Kossodo Sanitary District in Ouagadougou, a poor neighbourhood, formed by 5 villages, with a total population: 38.719 (19.749 men and 18.979 women). It gathers families that have recently immigrated to the capital city and are very attached to the traditions and belonging to different religions: Islam (80%), Christianity and traditional religions. The main production activities of Sector 27 are trade, horticulture, little jobs (maintenance, welding, etc.), waste collection and street cleaning (mostly women), agriculture in neighbouring villages, karité soap production. The existing health structures are 1 health and social promotion Centre, 1 consulting room, 1 clinic, 1 health Centre, 1 optical Centre, 4 micro pharmacies.
In Sector 27 of Ouagadougou A.I.Do.S. has established the "Centre pour le bien-être des femmes" (CBF) in partnership with the local organizations Voix des Femmes and Mwaganza Action, with private and public funds raised by A.I.Do.S.. It was inaugurated in November 2007 and is fully operational.
The Centre was constructed through an innovative project which conjugates local construction techniques with innovative solutions for energy efficiency (solar panels, a well) and environmental sustainability. It has a platform lifted up from the ground and a roofing that covers the building in order to improve natural ventilation, protect the buildings from the sun and collect rain water, gathered in tanks.
The Centre includes a team consisting of a gynaecologist, a midwife, a nurse, a psychologist, a lawyer and two social counsellors, linking the centre with the community. The Centre offers specialized medical and counselling services, specially focused on the issue of FGM/C; in particular it provides women with primary gynaecological care; pre and post-natal care; family planning information and services; birth spacing; prevention of sexually transmitted diseases; psychological assistance; social counselling; home visits in the cases of very disadvantaged subjects. The Centre also offers legal individual counselling services and group sensitization and awareness activities on women's own rights (marriage, heritage, divorce and separation, FGM/C, family law, domestic violence, children's custody, alimony). All the counselling activities are addressed to women adolescents and men.
The CBF has not reached financial sustainability due to the extremely low-income level of the population of the target area who can afford to pay only nominal fees for health care. Moreover, due to the difficulties to raise public and private funds in Italy during the last 4 years, the training of local staff have not been implemented.
The project aims to improve the physical, psychological and social well being of women, adolescents and men living in sector 27 of Ouagadougou, by attaining higher standards of sexual and reproductive health and by promoting the prevention of FGM/C- a traditional practice still in use throughout the country.

In order to achieve its objectives the project, which received a grant from the Nando Peretti Foundation, will implement the following activities:
1. CBF services
1.1 Health care and prevention services will be provided by a gynaecologist, a midwife and a nurse and include general medical consultations; primary gynaecological and obstetric care; prevention and detection of breast by ultrasound equipment and cervical cancer by pap smear; family planning services (information, counselling and provision of contraceptive methods in order to facilitate an optimal and responsible free choice), pre and post-natal care services (especially to young females who have recently given birth and who receive information on breast-feeding, family planning, baby care); prevention program on Reproductive Tract Infections (RTIs), Sexually Transmitted Diseases (STDs), Hiv/Aids and FGM/C.
The CBF activities will be carried out in tight connection and linkage with the existing governmental and non-governmental structures in order to share experiences through an enriching process and to facilitate synergies among operators in the field. The Centre has established an effective referral system with a large number of national and international, governmental and non governmental organizations working in the health, legal, social and psychological fields. This system has contributed to the improvement of the services offered by the CBF. The regular and mutual referral of cases between the centres and qualified and experienced organizations has allowed the Centre to offer women of Sector 27 an integrated and comprehensive package of services and to coordinate programs and optimize the distribution of the scarce available resources.
1.2 Psycho-social counselling for women, men and adolescents. Psycho-social counselling will be provided by one psychologist and two social counsellors at individual, couple and group level to women of all ages (from adolescence to menopause), men and youth suffering from psychological disorders, depression and/or victims of domestic violence, sexual abuse, FGM/C. The socio-economic aspect represents a very important component of the project as it is related to poverty, unemployment and social exclusion, which have a strong effect on women's reproductive health. The service does not provide financial assistance but offers social counselling and advice, refers women to governmental and non-governmental institutions offering financial or in kind support.
1.3 Legal counselling and awareness. Legal counselling will be provided to women by one part-time lawyer and a pool of volunteer jurists of the "Clinique Juridique" of the CBF. This service provides advice and assistance regarding a wide range of legal issues, including marriage, heritage, divorce and separation, FGM/C, family law, domestic violence, children's custody, alimony.
1.4 Youth Space services. Given the high rates of early pregnancies and adolescents' low awareness of gender and sexual and reproductive health issues, the CBF will conduct sensitization activities addressed to adolescents, by offering individual counselling as well as workshops and group sessions. Raising awareness activities will be implemented, especially by involving school students or adolescents' family members in order to sensitize them on the problems related to that age. A "Youth Space" has been established at the CBF in order to offer free services to the adolescents and young people of Sector 27 on Saturday mornings, when school is not in session. Services are provided by the CBF free of charge without appointment. Privacy is assured and working groups on sexual and reproductive health issues, trainings, and info-entertainment activities are offered.
1.5. Community awareness and education on FP&SRH. Community-based workshops on specific topics regarding several aspects of reproductive health will be organized at the CBF, throughout Sector 27 in co-operation with various organizations involved in the health/social sector and in public meeting places such as schools, community-based organizations, training centres, societies, clubs, homes, unions and committees.

A.I.Do.S. will be the executing agency. The NGO has a long expertise of management of SRH projects with an integrated, holistic approach, attentive to quality of care and gender issues. It will be in charge of project co-ordination and administration of finances, monitoring and reporting to the NPF. A.I.Do.S. will provide technical assistance and will also be concerned of integration of gender issues in the activities foreseen by the project.
Voix des Femmes (VdF) will be the local partner and will implement project activities on the field. VdF and CBF staff will be involved in the mobilization of women, men and adolescents, clinical and counselling service delivery, organization of workshops, monitoring and reporting. VdF will be involved in all stages of the project cycle.
The resources needed for the project implementation are:
Human resources. Expatriate staff: A.I.Do.S. program officer in Italy who will work on a part time basis will coordinate the project and ensure the correct and timing implementation of the project activities. She will monitor its implementation through 2 monitoring missions to Burkina Faso; 1 psychologist expert who will ensure the technical assistance and technical monitoring of the project activities during one 15-day technical assistance mission in the field.
Local staff 1 CBF Director (full time); 1 Gynaecologist (part time); 1 Midwife (full time); 1 Nurse (full time); 2 Community-based Facilitators (full time); 1 Psychologist (part time); 1 Lawyer (part time); 1 Secretary/Accountant (full time); 3 Wardens (full time); 2 Cleaners (1 full time and 1 part time); 1 Driver (full time).
Material resources Pharmaceuticals and Medical supplies, Stationary; Training materials; Education and information materials and tools; Refreshments for awareness activities.
Economic resources Local and international travel and per diems for A.I.Do.S. staff and experts; CBF running costs; Fuel, insurance and maintenance for one vehicle and two motorbikes; Maintenance of equipment; Transportation costs for awareness activities.
The project is proposing a model, which has been already tested by A.I.Do.S. in the past 19 years in six other countries including the Gaza Strip, Jordan, Venezuela, Argentina, Nepal and Syria. The methodology used has proved to be flexible and adaptable to different cultural, social, political, religious contexts. None of the Women's Health Counselling Centres (WHCC) established by A.I.Do.S. has closed, they are serving their respective community and have become a reference point for all the community's members, other NGOs, CSOs and often are used by the Government for training its staff.
Capacity building. As part of its strategy, A.I.Do.S. does not implement projects directly but gives the responsibility of project implementation to the partner organization in order to guarantee the project social and cultural sustainability and its continuation once A.I.Do.S. support comes to an end. The training given to the Centre staff by A.I.Do.S. consultants/experts is based on capacity building to promote quality and continuity of care, interaction, personalized assistance, informed choice and consent, respect and confidentiality. Each health service provider's specialized skills are identified and enhanced according to internationally accepted standards. Quality communication among the various providers is also stressed, together with the building up of an internal referral system between these specialists and determining further referral procedures to other centres or organizations for cases beyond the Centre's specific activities and capabilities. Linkages are established with secondary and tertiary level public and private structures and hospitals. The concept of family planning is also re-explored not just as a system of "fertility regulation" but to address the needs of women at different stages of their lives, with a specific focus on adolescents.
Team work. The staff, a team of professionals, bring together their specific know-how to enrich the group as a whole and to identify and offer new and possible solutions to problems faced by the Centre and its users. The choice of female professionals for almost all the job positions contributes to staff self-esteem and encourages women users to attend the Centres, as they find it easier to communicate their problems to other women.
Trainer as facilitator. For their field work, the staff is exposed to the concept that all service providers are also "facilitators" capable of listening and stimulating the "audience" to participate actively. They should focus extensively on organizing and managing group discussions, facilitating communication, empathy and exchange among adolescents - male and female - women of different age groups or with similar experiences, like victims of gender based violence and men. The role of the facilitator is to lead discussions and create the conditions for all group members to express their feelings and thoughts. Self-help groups may subsequently develop once harmony and trust have been established.
The involvement of the community is key to an effective implementation of the project, as this facilitates the relation and reciprocal understanding between the centre's staff and the surrounding community, the knowledge of their needs and concerns and the centre's ability to respond to them. This is generally achieved through education and participatory activities, such as workshops, seminars and "causeries débats" on different topics (safe motherhood, abandonment of FGM/C, women's human rights, SRHR, Hiv/Aids, forced and early marriage, etc), often organized outside the centre within the community itself.
The methodology that characterizes the Centre services is its proactive approach. Outreach services, dissemination of ideas and information will be achieved through workshops conducted outside the CBF and home visits. The Centre is not envisioned as a static entity to which women will turn to. Centre staff will be dynamic and mobile across the target areas, to ensure the involvement of the population and facilitate their participation, adapting visit and meetings to the women's needs and schedule.
The promotion of men's involvement in women's reproductive health issues is a very innovative and relevant component of the CBF, based on a gender perspective of reproductive health considering both the contributions of women and men as essential.

The anticipated achievements are:
- 4.000 women, youth, adolescents and children will have accessed health prevention and care services;
- 220 women, men, youth, adolescents and children will have accessed psychological counselling services;
- 200 women will have accessed legal counselling services;
- 8.000 women, men, youth, adolescents will have been exposed to awareness activities on RH and gender issues;
- 8 CBF staff members will have been further sensitised and trained on holistic and integrated approach to RH and on counselling skills.
The project is itself the replication and the adaptation of the successful model developed in Italy over the past thirty-five years and subsequently re-elaborated in other countries by A.I.Do.S.. The model has proved to be highly replicable and adaptable to the different local contexts.
A.I.Do.S. and VdF believe that the task of local NGOs is to implement projects that show what the real needs of women, adolescents and men are, and how they can be met, with the final aim of giving a contribution in shaping government policies and interventions.
The successful implementation of the project will demonstrate its impact in empowering women, in decreasing fertility rate, in reducing maternal and infant deaths and morbidity, in improving the health of new born children, in preventing the spread of STDs including Hiv/Aids, in preventing FGM/C, in educating adolescents.
At the community level, the project outreach and sensitization activities will contribute to a wider acceptance and understanding of issues related to women's, men's and families' health. This constructive attitude will pave the way to an increasing participation from the local community and demand for integrated health and counselling services. A multiplier effect is envisaged within the households' members who will benefit from the improved health and psychological status of women, men and adolescents accessing the CBF services.
At national level, networking activities will also provide opportunities to promote the CBF approach among other health care providers, namely Ministry of Health, as well as private doctors who might be interested in applying new methodologies to reproductive health.
At regional level, its modality can be replicated by other NGOs and government health facilities working in Western Africa, thus providing a model of intervention for other African countries.