Healthy Markets CoP Session - Liberia - August 30, 2023

The Healthy Markets Community of Practice (HMCoP) is a group dedicated to generating awareness of market development and private sector engagement work happening in different countries and for participants to leave with a greater understanding and appreciation of the country’s health market. The speakers for August represented FHM Engage, CHAI, Planned Parenthood Association of Liberia, Breakthrough ACTION, Last Mile Health, DKT, and UNFPA.

The August meeting of the Healthy Markets Community of Practice (HMCoP) focused on Liberia. We would like to thank our FHM Engage Liberia Technical Program Director Sophie Parwon for all her hard work in helping to organize this meeting.

To start the session, co-host USAID Senior Private Sector Advisor Andrea Bare reminded those that might be new to the HMCoP that this meeting is a continuation of the Total Market Approach Technical Working Group (TMA TWG) but with a new and updated approach that is focused on family planning (FP) and market development. She also announced that the former Drug Shops and Pharmacies (DSP) Community of Practice was invited to join the HMCoP due to overlap in focus of the two groups. Moving forward, the HMCoP will make a special effort to highlight DSP activities and topics as part of the overall approach. 

Following this announcement, HMCoP Lead Facilitator and FHM Engage Chief of Party for Tanzania Farhan Yusuf introduced the agenda and the speakers for the first presentation. In the next part of the meeting speakers gave rapid presentations on their work.  

Kristen Devlin, Data Integration, and Luke Krangar, Health Information System Specialist for FHM Engage, provided context for the family planning market in Liberia through an overview of FHM Engage’s Liberia Family Planning Market Description. This presentation focused specifically on applying market intelligence for FP in Liberia. Their presentation covered three main areas:1) defining market intelligence, 2) giving an overview of two market intelligence activities in Liberia, and 3) setting the stage for the possibilities of this work moving forward. Highlights of the presentation included a framework of approaches to strength market intelligence and possible outcomes to expect from these approaches. Through the market intelligence activities the project was able to determine that 37 percent of women source their FP from the private sector and that there is a large percentage of unmet need in youth ages 15 to19. This project also learned that data fragmentation is a key issue that needs to be addressed. 

Vekeh Donzo, Monitoring and Evaluation Manager, Clinton Health Access Initiative, presented on the findings of the depot medroxyprogesterone acetate in its subcutaneous form (DMPA-SC) pilot study, which focused on the acceptability and feasibility of self-injected contraceptives. The presentation gave an overview of DMPA-SC, which is an all-in-one self-injectable (SI) contraceptive, and the study highlighted that 95 percent of participants successfully self-inject at participating public health facilities. Furthermore, of the clients who completed the follow-up survey, 95 percent successfully complete SI at home for their second injection. This study underscored that SI is a convenient option for women that is discreet, easy-to-use, and is offered at significant cost and time savings. The study demonstrated that SI is a popular option for both clients and providers and has the ability to be scaled up. It also noted that other self-care interventions should be considered to improve population health outcomes.

Regina Hodges, Executive Director, Planned Parenthood Association of Liberia presented on an adolescent FP outreach project which works on demand creation for FP for youth. Demand creation activities included special community outreach sessions in 30 communities, nine health clubs in schools, and dialoguing with parents in four different communities and 15 faith-based organizations focused on FP. Through this work, some lessons learned included the importance of involving traditional and religious leaders, utilizing social media during outreach, offering training to those using social media to create more effective messages, and holding special community sessions outside of clinics to engage with a larger number of youth. Despite these successes, there remain persistent challenges, which include a lack of financial sustainability in providing adolescent sexual reproductive health (ASRH) services, youth refusal to easily accept ASRH/FP information, and the high cost of demand creation.

Jamesetta Gilayeneh Smith, Breakthrough ACTION gave an overview of Breakthrough ACTION, USAID’s flagship project on integrated social and behavior change intervention. The project works to increase FP use amongst sexually active adolescents and youth and has been implemented in 12 counties. Through this project, the adolescent health club approach was developed. By speaking with youth throughout the process, Breakthrough ACTION was able to improve and modify activities offered through the clubs. In the span of two years the project was able to create close to 500 clubs which cover a range of 16 different FP topics with a different topic covered each week and was able to recruit more than 7,000 participants. Some takeaways from this process include the importance of modifying the curriculum based on the needs and interests of participants, ensuring community participation and ownership, making sure the project was cost effective, and focusing on supervisor capacity to improve retention. 

Sara Hodges, Reproductive, Maternal, and Newborn Health Technical Advisor, Last Mile Health spoke on FP commodities distribution in public markets. This project worked to build a strong partnership with the Liberia Marketing Association for the distribution of FP commodities in order to increase access to FP commodities in public markets. Urban markets were chosen in two counties and the Market Association of Liberia provided a safe space for staff- referred to as marketers- to provide weekly market days in order to create FP demand and provide services. County health teams provided FP commodities (pills and condoms), data tools, monitoring and staff supervision, and provided awareness and referrals to clients opting for other FP methods. Benefits to this approach included: an increase in uptake of FP commodities; marketers were able to retain FP clients as customers; an increased opportunity to access FP after school when public facilities are closed; and confidentiality for all customers but particularly youth buyers. While drawbacks included a limited choice of FP methods for consumers and that the model is donor-driven, there were important outcomes from the project. For one, the project helped to dispel the myth that youth do not use FP and also the project empowered marketers by increasing their knowledge, which consequently led to business uptake. 

Isaac Opoku Lamptey, Country Manager, DKT Liberia focused on access to sexual and reproductive health rights, with a specific focus on commodities. DKT works to create access and availability of affordable reproductive health products through a variety of channels, generate awareness for products, and build capacity for service providers. DKT provides a full range of products which include condoms, pills, injectables, implants, medical abortion pills, IUDs etc. They have set up satellites and distribution locations across all 15 counties in Liberia to ensure effective distribution even in rural and difficult-to-access areas. A lot of work is done to create awareness and engage with youth through traditional mass media, social media, as well as non-traditional marketing locations like street vendors. DKT currently has a partnership with close to 400 private facilities and has established a network of clinics that they partner with where they provide support and resources. DKT has also built a wide network of collaborations with Liberian government groups and local and international NGOs. Through its work, DKT has been able to train 3,100 clinicians and 5,231 product providers in all 15 counties of Liberia. 

Maybe Livingstone, National Program Specialist, UNFPA covered FP demand creation in the southeast of Liberia and its impact on teen pregnancy reduction in the region. According to the 2013 DHS survey, the southeast of Liberia accounted for about half of the country’s teenage pregnancy rate. UNFPA currently employs a ‘three access point model’ to increase youth access to sexual reproductive health and rights (SRHR) services. The three access points model includes: 1) community, with women-led coaching/mentorship and community-based distribution of FP information and commodities, 2) school, where comprehensive sexuality education (CSE) was integrated into the national curriculum and training offered for mentors and coaches, and 3) youth, through friendly centers or health facilities that create a space that offers a mix of fun and confidentiality where youth can not only socialize but also receive SRHR information, services, and commodities. Using this model, UNFPA was able to have a significant impact in decreasing teen pregnancy as well as impacting other indicators of SRHR services like receiving prenatal care from a skilled provider and unmet need for FP. Key elements that enabled success included prioritizing multi-sectoral partnerships with government agencies, youth-led organizations, and civil society organizations and faith-based organizations, reopening the midwifery school, prepositioning of commodities and essential drugs before the rainy season, as well as capacity building for service providers specifically around adolescent friendly services. 

To end, we extend a great thanks to all who participated in this session on Liberia, particularly to those that took the time to speak and prepare slides. We are excited that there was such a positive response to this meeting and we are pleased with the continued thoughtful dialogue and connections being made throughout these sessions. We hope that participant engagement remains high and that organizations continue to share the progress of their work so that we may continue to facilitate this collective learning and look forward to continued participation in future sessions. 

Resources

We have a web page! On the new USAID Health Market Links website, managed by FHM Engage, you can find our past session recordings or revisit our newsletters. See the HMCoP page here:

Healthy Markets CoP | FHM Engage (healthmarketlinks.org)

Also, we are interested in hearing from those of you that have been engaged in the HMCoP.  Please use this survey as an opportunity to let us know your thoughts and if there are any changes you would like to see or feedback you would like to share.

Future Meetings

The next HMCoP convening will continue our conversation on Madagascar and will also address the integration of the Pharmacy and Drug Shops Working Group. The meeting is tentatively scheduled for September 27, 2023 and a calendar invite is forthcoming.  If you would like to take part in or contribute to this or another HMCoP session, or you would like to make us aware of an organization or project, please email Elizabeth Peña at (epena@FHM-Engage.org) or Jessica Jones (jjones@chemonics.com).

Questions?

Please email Jessica Jones (jjones@chemonics.com) or Elizabeth Peña (epena@FHM-Engage.org).