Advancing Sexual and Reproductive Health in Cabo Delgado (SPARC)


Reporting Organization:Aga Khan Foundation Canada
Total Budget ($CAD):$ 21,935,000
Timeframe: October 2, 2018 - February 1, 2024
Status: Implementation
Contact Information: Anisa Premji
[email protected]

Partner & Funder Profiles


Reporting Organization


Aga Khan Foundation Canada

Participating Organizations


Funders (Total Budget Contribution)


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Location


Country - Total Budget Allocation


Mozambique - $ 21,935,000.00 (100.00%)

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Areas of Focus


Health - Total Budget Allocation


Sexual Health & Rights (40 %)

Adolescent Health (30 %)

Reproductive Health & Rights incl. Maternal Health (30 %)

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Description


The project aims to improve the sexual and reproductive health and rights (SRHR) of some of the most vulnerable women and adolescent girls in six districts of Cabo Delgado province in Mozambique. It addresses SRHR barriers facing women and girls through three interrelated and mutually reinforcing efforts: improving the supply of services, so that quality sexual and reproductive health (SRH) services are available and effectively delivered; increasing the demand for and use of SRH services, which requires an environment where partners, families and communities understand the importance of SRHR and value women’s and girls’ decision-making power; and enhancing the use of SRHR information and evidence by key stakeholders. Project activities include: (1) building capacity of key district-level health workers; (2) addressing weaknesses with infrastructure, equipment and services (such as ensuring confidentiality); (3) strengthening referral systems, including for complicated post-abortion cases; (4) engaging men and boys as partners for change, sensitising community leaders, engaging community health committees; (5) providing family planning services through community health workers; and (6) generating and disseminating gender-sensitive research on SRHR and supporting the government’s capacity to collect, analyse and use SRH data effectively.

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Target Population


Gender and age: Adolescent females Adolescent males Adult men Adult women Children, boys Children, girls
Descriptors: Rural
Total Direct Population: 482,293
Total Indirect Population: 9,664
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Outputs


11 Health facilities renovated
14 Health facilities equipped
1,968 Community change agents trained
25 Scholarships provided
26 Government staff trained
44 Quality improvement action plans developed
547 Heath staff trained
624 Mobile clinics held
75 Community organizations trained
8 Public Engagement activities completed
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Results & Indicators


Expected Results


The expected outcomes for this project include: (1) improved delivery of gender and adolescent-responsive, environmentally-sensitive and comprehensive SRH services for women, girls, and their families; (2) reduced gender and social barriers to utilization and adoption of comprehensive SRH services and practices by women and adolescents; and (3) enhanced use and management of gender sensitive and adolescent responsive SRHR information and evidence by key stakeholders.

Achieved Results


Relating to Intermediate Outcome 1100 (Improved delivery of gender and adolescent responsive, environmentally sensitive, comprehensive SRH services and COVID19 prevention for women, adolescents, and their families), secondary data indicates a small increase in the number of births attended by skilled health personnel (indicator 4).  Whilst it is important to bear in mind potential secondary data inconsistencies, this could also be in line with the huge efforts to include services, for example through the establishment and strengthening of quality assurance teams, increase involvement of communities in the health services (through co-management committees) and the various information and communication spread to communities about the use of health services. However, the percentage of adolescent girls and women 15-49 years currently married or in union with unmet need for family planning (indicator 5) is reportedly increasing (comparing IMASIDA 2015 and DHS 2023 data). The reasons may be linked to the issues presented above in indicator 1. It is hard to discern whether this relates to SPARC target districts as this is data for the total province, however this is most likely linked to insecurity challenges – for example several health facilities in the province have been closed and insecurity has prevented even mobile health brigades from operating; people have been displaced and their livelihoods destroyed making SRH a lower priority as they struggle to survive, theft of medicine by insurgents has increased stock outs. In Nangade, mobile health brigades only restarted this year. SPARC has continued to work with health services to increase access to family planning and other SRH services, and in this period procured both abortion medicine and emergency contraceptives for key health facilities. Abortion medicine is already distributed.  Also, linked closely to the VCAT sessions conducted with health professionals in Y4, there number of facilities offering abortion services significantly increased this period.

Relating to Intermediate Outcome 1200 (Improved utilization of gender and adolescent responsive, environmentally sustainable comprehensive SRH service and COVID19 prevention by women and adolescents), and reviewing secondary data from SISMA, there appears to be continuing to increase the percentage of women who have attended at least four antenatal care visits with health care providers in the districts of Namuno, Montepuez and Chiure (see graph 3). This could partly be related to the increase in integrated mobile health brigades (MHBs) supported by SPARC and community structures (Community Health Committees, CHC, Change groups and CHWs) advocating for women to attend sessions. SPARC services differ to what other NGOs are supporting government with as SPARC ensures integrated  services are offered. The CHWs and CHCs also increased significantly the number of community sensitisation events conducted in this semester, and this no doubt caused a bump in the use of outreach services (MHBs and access to FP from CHWs). AKF acknowledges that challenges remain in key areas, for example referral and follow-up systems from CHW/MHBs to health facility still needs to be strengthened to ensure there is no loss of support during pregnancy.

Relating to Intermediate Outcome 1300 (Enhanced use of gender sensitive health information and evidence by key stakeholders in Mozambique and the Canadian public), there are already significant improvements in the data being collected at health facility (by staff within the facility and during mobile health brigades) and community level (through community health workers). Data is increasingly gender-disaggregated, and health facilities are routinely logging patient data. A challenge that is important to reflect upon is the heavy paper burden of current data collection. AKF, like others, is trialing digitised data collection – in this project this is done with community health workers (CHWs). However, challenges that hamper this relate to network and internet connectivity and electricity availability in rural and remote parts of Cabo Delgado.

In Year 4, AKF conducted a data quality assessment to understand the percentage of target health facilities that are using gender-sensitive HMIS data to inform planning (indicator 13). The assessment revealed that all 43 assessed had begun using gender-sensitive data. Success here is a result of the comprehensive training and routine meetings (monthly district-level data discussions) with health facility staff on data quality assessment, analysis and use of data for planning. The two hospitals (Montepuez Rural Hospital and Chiure District Hospital) were not assessed during this period, however will be included in the Y5 assessment.

Indicators


MNCH-related indicators
  • %/total of women attended at least four times during pregnancy by any provider for reasons related to the pregnancy
SDG Goal 3. Ensure healthy lives and promote well-being for all at all ages
  • SDG 3.7.1 Proportion of women of reproductive age (aged 15–49 years) who have their need for family planning satisfied with modern methods
SRHR-related Indicators
  • # of advocacy and public engagement activities completed which are focused on SRHR
  • # of health care service providers trained in SRHR services
  • # of national laws, policies and strategies relating to SRHR implemented or strengthened
  • # of women and girls (age) provided with access to sexual and reproductive health services, including modern methods of contraception
  • % of primary service delivery points with least 3 modern methods of contraception available on the day of assessment
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Associated Projects (If applicable)


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