[ HOPE 2020 ]

Project proposal on Adolescent Sexual Reproductive Health and Family Planning In Oromia Regional State, West Shoa Zone, Jeldu Woreda
July 2007
Addis Ababa, Ethiopia            

[ Project Summary ]

Project Title: Adolescent Sexual Reproductive Health and Family Planning
Project Location: Oromia Regional State,West Shoa Zone,Jeldu Woreda
Project Total Cost: Birr 802,604 /$ 89, 178 USD /
Implementing Agency: HOPE 2020
Project Duration: Three years
Direct Beneficiaries:     22,500 Adolescents of the project area 
Indirect beneficiaries:   150,000 inhabitants of the project area

 (Contact Address)
[Addis Ababa, Ethiopia]
Tel: (251)-(012)-707533 /Office/
Cell phone:(251)-(911)-175360
Fax:  (251)-(012)-707534
Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it , This e-mail address is being protected from spambots. You need JavaScript enabled to view it

(Contact Person)                       
Gudeta Gelalcha, /Executive Director/
P.O.BOX.24198/1000

 

Introduction 

Brief Profile of the Organization

HOPE 2020 is a non-governmental, non-political, non-religious local NGO established in 2004 with the general objectives of improving the life of the rural communities through providing potable water, hygiene and sanitation services; introducing modern irrigation systems; increasing the rural community’s awareness on HIV/AIDS prevention; providing the necessary care and support for orphans and vulnerable children; reducing gender inequality through women empowerments and contributing its part to environmental protection.

It is a legally registered association by the Federal Democratic Republic of Ethiopia Ministry Of Justice with registration certificate number 1865 and is licensed to operate as an NGO in its particular areas of interest and intervention meeting all the legal requirements. It has also an operational agreement with Federal and Oromia Food Security Disaster Prevention and Preparedness Commission.

In line with its memorandum of association and relevant laws of the country, the association has a Board of Directors, a governing body that provides leadership and direction on strategic issues   such as strategic and annual plans, annual budget, salary schemes, and exercise control to ensure that the association is operating within and inline with the laws of the country and its own constitution. It has a General Manager responsible for giving over all directions for the day-to-day operations of the association inline with the directions and decisions of the Board of Directors.

Currently HOPE 2020 implementing water supply, sanitation, hygiene promotion, HIV/AIDS prevention, care and support, orphans care and support and other projects in Saden Soddo, Woliso and Tole weredas of South West Shoa zone of Oromia National Regional State.

The association’s integrated rural development programs to solve the various socio-economic problems of the rural community attracted international NGOs like Water Aid-Ethiopia, Comitato Internazionale per lo sviluppo dei popoli (CISP-Italian based international NGO) and Water Millennium Alliance (USAID) which are currently working as a partner with the association.

Vision, Mission and Objectives

Vision

HOPE 2020 has a vision to see a health, gender balanced, prosperous and productive society that live in a clean and fresh environment.

Mission

• Improve the health situation of the rural community by increasing their access to potable water and promoting hygiene education and environmental sanitation
• Fight the spread of HIV/AIDS and its associated problems
• Improve the livelihood of the rural community through introducing modern irrigation practices and by establishing saving and credit schemes
• Increase the rural communities access to basic education and health services
• Create gender-balanced society through women empowerment activities
• Protect the environment through natural resources management and  introducing alternative energy sources.

Objective

The general objective of the organization is to alleviate poverty by supporting and stimulating the economic and social growth of the rural communities with priority to children, women and the elderly.

Background of the project

Reproductive health implies that the capability to reproduce and the freedom to decide if, when and how often to do so. It is the rights of men and women to be informed and have access to safe effective affordable and acceptable methods of family planning of their choice and the right of access to appropriate health care services that will enable women to go safely through prevention and solving reproductive health problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations and not merely counseling and care related to reproductive and sexually transmitted diseases (USAID, 2003).

The reproductive health concept recognizes the degree to which individual needs arise not only as a consequence of purely biological circumstances, but also of events that might be more culturally, socially, or ethnically defined. Thus the scope of reproductive health includes concerns over women’s status and the guarantee of human rights. Finally, the concept acknowledges the reproductive health needs of all individuals, including those of men and adolescents (Save the Children, 2004).

 

Adolescent Reproductive and Sexual Health 

Overview of Adolescent Reproductive and Sexual Health

As the information from population reference bureau (PRB), more than a quarter of the world’s population is between the ages of 10 to 24, of these adolescents, the vast majority 86% live in developing countries. Besides this fact, adolescent worldwide lack basic information about their bodies and the power and means to protect themselves and make informed decisions about their lives. They become victims of early arranged marriages; early and unwanted pregnancies and births, sexually transmitted diseases including STDs/AIDS; illegally induced, unsafe abortions; female genital mutilation; sexual violence and exploitation; pregnancy associated morbidity and mortality; school dropout and overall curtailed life options due to early child bearing (Pathfinder international, 2001).

One of the most sensitive issues associated with adolescence is sexuality. They receive inadequate educational guidance and services that help them make the transition to adulthood. Often they are denied complete access to reproductive health information and services. With their limited knowledge about their bodies and their sexuality, they are vulnerable to sexually transmitted diseases and infections including HIV/AIDS, substance abuse, sexual exploitation and violence. Girls are further vulnerable and face higher risks due to their lower educational status and inability to negotiate on issues related to reproductive and sexual health.

Thus, it is not surprising when one encounters these facts:

• One in every ten births world-wide is to teenage  mothers
• One in every six births is to young women aged 15 to 19 in least developing countries.
• Pregnancy before age 18 has many health risks and girls below age 15 are five times more likely to die in pregnancy or childbirth than women aged 20 to 24.
• At least one in ten abortions world-wide occurs to women aged 15-19 years and more than 4.4 million young women in these age group have an abortion every year, 40 per cent of whom are performed under unsafe conditions.
• Every day, 500,000 young people are infected with an STD most in the 20 to 24 years group, followed by those in 15 to 19 age group (UN Special Session on Children, May 2002).”

The lives of millions of adolescents worldwide are at risk because they don’t have the information, skills, health services and support they need to go through sexual development during adolescence and postpone sex until they are physically and socially mature, and able to make well-informed and responsible decisions.

The main issues in adolescence sexual and reproductive health include sexual development and sexuality including puberty, sexually transmitted diseases/HIV/AIDS and unwanted and unsafe pregnancies. The reasons that adolescents are at risk include:

Social and economic environment - For millions of adolescents, sex is linked with coercion, violence and abuse-some times even by family members or adults with privileged relations. In many societies women are conditioned to be submissive to men, and they find it difficult or impossible to refuse early marriage, to space births, or to refuse to have unprotected sex with an unfaithful spouse or partner. Additionally, the social environment is critical to healthy adolescent development. There are key aspects of this environment which can prevent adolescents from engaging in unsafe / unwanted sexual behavior like strong relationship with parents, a connection to school and open communication with sexual partners.

Life and livelihood – In most countries, the great majority of adolescents are poorly informed about sexuality and reproduction. Many believe that withholding information about sexuality and reproduction from young people will dissuade them from becoming sexually active. In fact, good quality sex education does not lead to earlier or increased sexual activity among adolescents. Adolescents need life skills in order to face the challenges of adulthood. Many adolescents are victims of exploitative sex because of lack of livelihood skills and opportunities.

Access to health services – Most adolescents become sexually active before the age of 20, but generally lack access to family planning services including appropriate contraceptives, prevention and care of sexually transmitted diseases, or pregnancy care. For many young people the opening times or locations of services make them inaccessible, or the care is beyond their financial capacities. Many health care facilities require the consent of their parents or spouses or may be forbidden by law to provide services to adolescents. In addition the judgmental attitudes of many health care professionals often discourage adolescents from seeking advice and treatment related to sexual and reproductive health.

Synopsis about Adolescent Reproductive Health in Ethiopia

Ethiopia is located in the eastern part of Africa neighboring the Sudan, Eritrea, Djibouti, Somalia and Kenya. It is the third largest country in Sub-Saharan Africa with a total area of 1.13 million sq km. and estimated population of 75 million 0f which 17-20 % account for urban population. Children between the age of 0 -14 years accounts for about 47 %.The total population growth rate is estimated to be 2.9 % while the birth rate is 46/1000(Country Profile).

The combination of rapid population growth and low per capita income typify the country’s extreme level of poverty. Forty-five percent of the population lives in poverty with 47 percent of the rural population and 33 percent of the urban population falling below the poverty line. The country is characterized by an expanding youth population. It is estimated that young people age 10-24 constitute more than a third of the population, about 25 million. The economic, political and social situation in Ethiopia has seriously affected this group. Access to education and health services remains limited, particularly for young rural women and men, and unemployment is a problem, particularly among young people living in urban areas.

Ethiopian youth face a multitude of problems caused by poverty, traditional beliefs and misconceptions. As an age group, their material, social, health and reproductive needs have not been given the required attention. Government policies and programs tried to address the needs of youth along with those of the general population though youth have special needs that require different policies and program efforts.

The reproductive health problems of young people in Ethiopia are multifaceted and interrelated. Childbearing begins at early age: 45 percent of the total births in the country occur among adolescent girls and young women. Sexual violence and commercial sex work have become common phenomena among young girls. As a result, they have become primary victims of the HIV/AIDS crisis that has spread through out the country. In general, young people are at high risk of reproductive health problems aggravated by the overall poor socio economic environment and harmful traditional practices and which needs a timely and all sided interventions. Project Target and Location

Project Target and Location 

Background Information about the Project Area

Oromia Regional State is located in the center of Ethiopia and is the most populous regional state with 32.3 % of the country’s population. It occupies one third of the nation area about 363,081 square kilometers. Based on the 1994 population and housing census, the projected population of the region was estimated at 23,704,000 with 2.9 % annual growth rate. Among the population, 45% are below 15 years old and economically active age group is about 50%. Out of the population 88% live in rural area and 12 % in urban areas.

Jeldu wereda is located 70 km from Addis Ababa on the main road to Ambo and 37 km from the main road on the way to Gindabarat in West Shoa Zone of Oromia Regional State. It has 4 urban Kebles and 38 rural Kebles with a total population of about 150,000. There is one health center and 6 health posts in the district.

This district is selected because:

• It is one of the project areas in which HOPE 2020 is currently implementing water supply, sanitation and Hygiene project, subsequently theses kebeles are familiar for HOPE 2020 and the implementation of the project will be facile.
• The relatively high population the district has.

Target Groups

The project mainly target on adolescents between the age 10-24 and the direct beneficiaries are about 22,500 of adolescents of the project area. The target group includes:

• Adolescent females who are not yet sexually active (10 to 14 years)
• School and out of school adolescents and youths living in the project area.
• Those who are married and sexually active.
• Unmarried sexually active adolescents.
• Sexually active single mothers.
• Commercial sex workers.
• Those at risk of genital mutilation
• Sexually active inhabitants of the project area.

 Statement of the Problem 

Ethiopia is one of the highest-ranking countries in reproductive health risk worldwide with a maternal mortality rate of 1800 per 100,000 deliveries; trained personnel attend only 6 percent of birth and 42 percent of pregnant Ethiopian women have anemia. (Country Profile HIV/AIDS-Ethiopia, Dec.2003). Besides almost in all of the countries rural areas, no clinical services tailored for young adults in the public sector though young adulthood is a newly acknowledged life phase in many regions (Judith Senderwortz, 1997).

The prevalence of HIV/AIDS in Oromia regional Sate including in the project area, Jeldu District, among the age groups of 15-49 yrs is 2.44% in 2005. Among the urban population the  revalence is 8.4% and 1.42% in rural areas in the same year. A total of 318,382 persons are living with HIV/AIDS in the regional state among which 33,213 are children below the age of 14 yrs. (AIDS in Ethiopia 6th Report)

According to the information from the Jeldu woreda administrative office, 83% of the people know about HIV/AIDS but awareness on the protection method is found rather low and HTPs is highly practiced. Awareness on RH and HIV/AIDS among the youth is not satisfactory.

Generally, the woreda’s Reproductive health issue is characterized by:-

• There is great difficulty for unmarried adolescents in accessing to reproductive health services.
• Most of the adolescents are too embarrassed to attend an open family planning or reproductive health clinic and they anticipate the negative attitudes they will experience from clinic staffers.
• Teenage pregnancies and adolescent ignorance of their sexuality and their reproductive right.
• Young women who become pregnant will be shunned by their parents and forced to leave home.
• Schoolgirls who become pregnant rarely return to school whether they are married or not.
• fter pregnancy women’s decisions is mostly influenced by male partners.

Negative cultural practices coupled with poverty have a devastating effect on ARH of young women of the woreda and sexually Transmitted infections (STI) are another challenge for young people in the program area. And the problems will become aggravated if further actions are not taken.

As a response to the above-mentioned problems, HOPE 2020 seeks for potential solutions as to how the problems can be minimized (if not alleviated) through creating public awareness on Gender integrated ARH and HIV/AIDS project. Therefore, HOPE2020 has prepared this Community Based Reproductive Health Facility Project to be implemented in Jeldu district in west Shoa Zone of Oromia region in partnership with the communities in the area, Oromia Regional State and donor organizations.

The organization will underline the importance of fighting harmful traditional practices and ARH and HIV/AIDS awareness to achieve gender equity and improve health status of the communities.

 

Project Objectives

General Objective:

The general objective of the project is to reduce adolescent sexual reproductive health problems and youth vulnerability to HIV/AIDS pandemic in the project area.

Specific Objectives:

• Improve the reproductive health knowledge, attitudes and skills of 22,500 adolescents in the project area in the coming three years.
• To bring behavioral change on 80% of adolescents in the district on sexual and reproductive health and other health related issues in the project area during the project period.
• Decrease youth vulnerability to HIV/AIDS by 90% in the project area in the coming three years
• Create a supportive environment for the adolescents on their right on safe sexual practice in the project area
• Increase adolescents’ reproductive health services and programs by 75%.
• Increase communities awareness on adolescents sexual and reproductive health rights by 70%
• Provide educational materials support for 84 HIV/AIDS orphans in the project area for the next three years. (Activities to be carried out)

Activity Description (Activities to be carried out)

Recruit one project coordinator for implementation of the project

• Establish and train six AACs that work on HTPs/HIV/AIDS prevention and ASRH issues and family Planning.
• Conduct training to club leaders on planning, implementing, reporting, and record keeping of their activities.
• Train FBO and community leaders on community mobilization strategies and ASRH/ HTPs / HIV/AIDS.
• Training of women groups on Reproductive Health and Family planning.
• Produce and distribute IEC/BCC materials on HTP/HIV/AIDS/ASRH/ Family planning.
• Provide material support for AACs.
• Recruit and train Community Based Reproductive Health Agents /CBRA/
• Referral for fistula repair for the needy
• Conduct community conversation session on child-parent discussion on sexual matters.
• Orphan children support
• Discussion with the district health center staffs on progress of ASRH rights and issues.
• Mid term and terminal evaluation

       Inputs of the Project

• Manpower – employed, invited and volunteers,
• Materials – Offices equipment, training material.
• Fund for project implementation.
• Places- office and hall room.
• Time spent by the community on workshops.        

       Anticipated Outcomes of the Proejct

• FBO Leaders and community leaders’ awareness of ASRH, HTPs and HIV/AIDS issues will be enhanced in the project area

• Increased adolescents awareness on their reproductive health right and family planning.
• Number of people visiting VCT centers increased in the project area
• Awareness of local community about, ASRH and HIV/AIDS issues increased.
• Community and religious leaders become actively involved to overcome harmful traditional practices.
• The prevalence of harmful traditional Practices decreased significantly.
• Health centers staffs’ awareness on Adolescents reproductive Health Rights increased.
• Parents’ awareness on adolescents’ sexual and reproductive rights in the project area increased.
• Sexual violence in the project area decreased.
• The demand for contraceptives increased by 75 % in the project area.
• 15 fistula patients get treatment.
• 84 orphan children supported

Sustainability of the Project

HOPE2020 uses the approach “Help the communities to help themselves”; consequently Community participation, and provision of training and involvement of government and other stakeholders will be given crucial consideration for sustainability of the project.

The AACs will be assisted to run the project by themselves by enhancing their resource mobilization skills through training, and providing the necessary material supports.

 

Project Management 

HOPE 2020 is responsible for the management of the project. This will be done through employing a qualified and experienced project coordinator to be based at the project site. He/She will be responsible to support and follow up implementation of the project at the district. The project coordinator will work in close collaboration with local partners and will be reporting to HOPE 2020 head office where centrally compiled report would be sent to all stakeholders.

 

Project Monitoring and Evaluation 

Periodic monitoring focuses on the day-to-day activities of the project. It uses clearly stated activity indicators in the plan for monthly, quarterly and annual targets to be accomplished. Monitoring activity includes measuring the physical performances, budgetary utilization, quality and quantity of work done, correlation of the work done with the set objectives and the set plans and timetables. A mid term evaluation will be jointly held with all stakeholders including beneficiaries, donors, HOPE 2020, Community, Faith Based Organizations, concerned government line offices and civil society organizations.

During the evaluation process the following indicators will be considered:

• Number of adolescents reached
• Number of AACs formed
• Financial system, cost effectiveness and budget utilization
• Participation of stake holders
• Net work created and strengthened
• Number IEC/BCC materials printed and distributed
• Demand for VCT services in the area
• Declining of HIV AIDS prevalence rate in the project areas
• Number of orphans supported.
• Number of fistula patients treated.Proposed Implementation Strategy and Partnerships.

Project Implementations Strategy and Partnerships 

HOPE 2020 will work with local partners including government line offices, local community structures including, the traditional funeral association, (Idir/Shengo), and women Mahiber and Faith Based Organizations and civil society organizations. After the official approval of the project, HOPE 2020 will work on the detailed implementation plan including timeframe, physical and financial plan and cash flow strategies

 

Budget Summaries in Birr 

Budget Narratives 

• The amount of fund required for this three-years Community Based Reproductive Health Project is Birr 802,604/USD 89,178/for the project sites.
• 11% of the project fund shall be used for increasing communities’ awareness of Reproductive Health, HTPs, and HIV/AIDS and family planning concepts.
• 17% of the project fund shall be used for six Anti Aids Club Formation, training & support
• 25% of the project fund shall be used for CBRH agents selection and training
• 13 % of the project fund shall be used to provide school and hygienic material support for 252 orphans in the project area with in three years.
• 5% of the project fund shall be used for referral to 15 fistula treatments.
• 15% of the project fund will be used to hire project coordinator at the project site for three years.
• 2% of the project fund will be used for monitoring and evaluation.
• 2% of the project fund will be used for institutional capacity building
• 10% of the project fund will be used for administrative purposes both at head office level and at the project site for three years. 
• Facilitation, coordination and logistic support will be provided by HOPE 2020.