THE SIGNIFICANCE OF OUTREACH PROGRAMS IN
MEETING THE SEXUAL AND REPRODUCTIVE SERVICE DEMANDS OF WOMEN. A CASE OF PPAZ, KITWE
Since its inception in Zambia in 1972, Planned Parenthood Association of
Zambia (PPAZ) has been working to empower women’s sexual and reproductive
health rights by offering free sexual health service delivery such as family planning,
voluntary counselling and testing
(VCT) for HIV, the treatment of sexually transmitted infections (STIs),
antenatal and post-natal care, emergency contraceptive provision, laboratory
tests, and screening. While oral and injectable contraceptives are meant for
family planning purposes only, condoms (male and female) have a dual protective
role or preventing fertilisation from occurring and transmission of Human
Immunodeficiency Virus (HIV) which causes HIV/AIDS. The 2013-2014 Zambia
National Demographic Health Survey (ZNDHS) has shown a continual rise in the
cases of unplanned pregnancies, sexual and gender based violence and new HIV
infections among women. Further, the current status of women’s sexual
reproductive health and rights is shocking; 225 million women worldwide lack
access to contraception and 800 women die daily from preventable causes related
to child birth (Global Fund, 2016).This has prompted PPAZ to expand its work
stations throughout Zambia in an effort to enhance a wider coverage. It has
strategically positioned itself and has become a spotlight to the risky and
hard to reach population groups in Zambia. One of PPAZ well embraced and
cherished ideologies is its belief that a woman’s ability to have total control
of her own body and access the health services she needs regardless of her
sexuality, demographic, income and ethnicity and cultural status is her
fundamental right.
Among the notable hindrances to the smooth delivery of
contraceptive services in Zambia are culture and customary laws especially in
rural areas. For instance myths associated with contraceptive use such as
“Contraceptives make women infertile’’ are common and accepted beliefs in most
rural areas and some urban areas in Zambia. Outreach workers therefore face
potential challenges in convincing women with deep rooted cultural beliefs in
these areas to embrace the scientific value of contraceptives in a woman’s life.
Arguably, in most societies in Zambia, it’s a taboo for a woman to have a say
on contraceptive use and a man has all patriarchal rights to decide whether to
use contraceptives or not. This is even worse among girls with no trace of
education background and who are forced into early marriages. Hence, many women
are being exposed to the high risk of unplanned pregnancies such as abortions,
infertility and maternal death as suggested by the ZNDHS. Invariably, many in
marriages are unable to attain any form of education due to excessive domestic
and cultural tied responsibilities which sometimes comes with bearing and
raising children. Similarly, access to full reproductive and sexual health services
is also impeded by lack of health facilities and health posts in many parts of
Zambia; hence many people in these areas have succumbed to the traditional and
cultural practices for health care.
In view of above, PPAZ has developed a strategy to deliver
free sexual and reproductive health services through community based outreach
programs mainly targeting women of reproductive age. One noticeable example is
its operations in Kitwe Zambia; it has prioritised community outreach programs
as the mainstay strategy for its service delivery. Through a devised weekly
outreach programs in various parts of Kitwe, hard to reach and marginalised
populations groups and women who have no access to antenatal and contraceptive
services have been reached. Further, on weakly basis a team of health workers
is dispatched to some remote places to offer these services. This ensures a
weekly contact with most of the women lacking these services.
These programs are aimed at bringing the reproductive and
sexual health services as close as possible to the people, which is in
congruence with the vision of the Ministry of Health Zambia. Further, Focus
Group Discussions (FGDs) are the means used in outreach programs by PPAZ health
workers to elicite information on certain critical sexual health issues
affecting women. FGDs are not a new phenomenon in social science research; they
have been extensively used in qualitative research on phenomena of which little
is known. They provide a platform on which the lived experiences of the target
groups or population of interest are explored. In the case of PPAZ Kitwe
outreach programs, most women find it easier to express themselves freely on
matters to do with their sexuality due to the influence of group dynamic. For
instance below is an excerpt from one of the women who had attended PPAZ
Racecourse based outreach program in Kitwe:
‘’these injectable contraceptives are better because they
allow us women to have control over our bodies and we can therefore decide when
to have children’’ Female participant, PPAZ Racecourse outreach, Kitwe, 2016.
In addition, the value of these community based outreach
programs cannot be overemphasized. Firstly, not only has PPAZ Kitwe managed to
access hard to reach population groups
at risk, they have penetrated into hidden and marginalized
communities and have established and
built strong relationships with people in the communities which is pivotal to
effective delivery of sexual and reproductive health services among women.
Undoubtedly, the evidence of the effectiveness of a community-based outreach
strategy for public health policy and decision-makers is compelling; many
successful HIV prevention intervention programs have used outreach programs
especially where there is need to reach marginalised populations such as gays
and injecting drug users. The strategy behind these programs is that most of
them are delivered outside of the
traditional office setting and as a way of making contact with people who are
not connected with formal services. Through these, PPAZ Kitwe has expanded the
scope of its services and thus delivers information and services to women in
inaccessible places.
Peer involvement also plays a significant role in the
effectiveness of community based outreach programs. PPAZ Kitwe has
strategically involved peers including young girls to help promote healthy
behaviours among populations of different age groups in schools and
communities. Not only does this empower young people to take up responsive
roles in the society, peers are easily influenced behaviourally when the information
is delivered by fellow peers. Hence, peer-driven outreach programs
are critical not only in bringing prevention messages to marginalised and hard
to reach populations, but also to connect risky populations to essential care
and treatment services.
Importantly, determining the best ‘package’ of strategies for
an outreach program is dependant on contextual factors (such as available
resources and program objectives) and an organization’s relationship with the
target population. Firstly, connecting with people is essential in establishing
the relationship as it creates bridges between services and people who are not
comfortable coming into institutional settings such as clinics and offices.
Secondly, the development of trust and relationships between service providers
and people in the community opens doors for a more comprehensive approach to reproductive
and sexual health programs. This has been PPAZ mandate since its inception and
many women in Kitwe are now in full access of reproductive and sexual health
services.
In conclusion, access to contraceptive services and cultural
norms that empower women to make their own reproductive choices are
prerequisite to empowering women’s sexual and reproductive health and rights.
Appropriate and specific community based outreach programs that address these
and provide a platform on which women’s sexual health issues can be head and
addressed are cardinal. In designing outreach programs to access the hard to
reach population groups among woman, it is always important to realise that a woman
is only reproductively and sexually empowered when she has total control of her
own body and has a complete access to sexual and reproductive health services
regardless of her educational, ethnicity, demographic and income status.
By Bright Mukanga
(Research Associate, Reproductive and Sexual Health, PPAZ,
Kitwe)
