Meeting the Sexual and Reproductive Health Needs of Internally Displaced Persons in Ethiopia’s Somali Region: A Qualitative Process Evaluation

Kathryn A. O’Connell; Tesfaye Shiferaw Hailegebriel; Danielle Garfinkel; Jenna Durham; Bereket Yakob; Jemal Kassaw; Addisalem Titiyos Kebede

doi:10.9745/GHSP-D-21-00818

Key Findings

Maintaining strong partnerships, cocreating activities with local stakeholders, coordinating with the existing health system, and aligning interventions with national priorities are key to effectively addressing the sexual and reproductive health (SRH) services needs within communities of internally displaced persons (IDPs).
Fragile security conditions, retention of trained providers, and barriers toward sexual and gender-based violence services had detrimental roles in improving access to SRH services among IDPs, which were exacerbated by coronavirus disease (COVID-19).
Lessons and successful approaches identified by those closest to the project, including IDPs who received services, health facility staff, and local government partners and partner organizations working in this space, offer a path for effective prioritization of sexual and reproductive health and rights (SRHR) within IDP and similar humanitarian contexts.

Key Implication

Program implementers should prioritize SRHR in IDP settings. The results of this process evaluation add to the evidence base on the effective delivery and implementation of SRHR programming for IDPs in humanitarian crises.

ABSTRACT

Introduction:

Meeting the sexual and reproductive health and rights (SRHR) needs of internally displaced persons (IDPs) is critical. Despite increased prioritization and coverage of sexual and reproductive health (SRH) services in humanitarian settings in recent decades, significant unmet needs remain. In Ethiopia, there are more than 2 million IDPs, an estimated 40% of whom have unmet need for modern contraceptives. To address this, EngenderHealth implemented a model of SRHR programming in Ethiopia’s Somali region. We share the lessons learned from this project to improve access to SRH services among IDPs.

Methods:

In 2021, an independent research team implemented a qualitative process evaluation among 13 key informant interviews (KIIs) with health system actors, local government partners, and organizations, and 4 focus group discussions (FGDs) with community members and community health volunteers. The team selected participants purposively following the maximum variation sampling technique and analyzed the data in NVivo 12. The team used KII and FGD guides to explore and understand what was implemented, which stakeholders were engaged in the processes and how, what was achieved, and the barriers and facilitators in implementation.

Results:

Contributions to project achievements included strong partnerships and stakeholder engagement, an enabling environment for SRHR, improving health worker capacity, and flexibility and adaptability. Challenges included a fragile security situation, retention of providers, and difficulty in accessing gender-based violence services, exacerbated by the coronavirus disease (COVID-19) pandemic.

Conclusion:

Our article offers guidance for organizations and government entities seeking to design and implement SRHR programs in humanitarian settings. Findings highlight the importance of prioritizing SRHR programming in IDP settings and illustrate adaptable activities to assist with project implementation and minimize operational challenges.

Received: March 27, 2022.
Accepted: September 26, 2022.
Published: October 31, 2022.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-21-00818

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