Cutherell Meghan, Bwire Juliana, Mtei Edwin, Musau Abednego, Kahabuka Catherine, Luhanga Isabellah, Julius Augustino, Kihwele Gerald
Population Services International (PSI), Washington, DC, United States.
Population Services International (PSI) Tanzania, Dar es Salaam, Tanzania.
Front Glob Womens Health. 2023 Mar 15;4:942418. doi: 10.3389/fgwh.2023.942418. eCollection 2023.
From 2018 to 2020, Adolescents 360 (A360), aiming to increase demand for and voluntary uptake of modern contraception among adolescent girls 15-19 years, designed and scaled an intervention in Tanzania (Kuwa Mjanja) to 13 regions through project-funded expansion. In 2020, the project began to develop a strategy for its follow-on phase, focusing on program sustainability. In this process, funder priorities led to a decision to exit A360's programming in Tanzania over a 15-month exit period. A360 elected to pursue a process of expedited institutionalization of Kuwa Mjanja into government systems during this period.
The institutionalization process was facilitated in 17 local government authorities in Tanzania. Quantitative and qualitative data were gathered and analyzed including time-trend analysis of routine performance data, statistical analysis of two rounds of client exit interviews, and thematic analysis of qualitative research.
The sociodemographic characteristics of adolescent girls reached under government-led implementation were comparable to those reached by A360-led implementation. Intervention productivity decreased under government-led implementation but remained consistent. Adopter method mix shifted slightly toward greater long-acting and reversible contraceptive uptake under a government-led model. Factors that enabled successful institutionalization of Kuwa Mjanja included the presence of youth-supportive policies, the establishment of school clubs which provided sexual and reproductive health education, commitment of government stakeholders, and appreciation of adolescent pregnancy as a problem. Some intervention components were important for program effectiveness but proved difficult to institutionalize, primarily because of resource constraints. Lack of adolescent sexual and reproductive health (ASRH)-focused targets and indicators disincentivized Kuwa Mjanja implementation.
There is significant potential in operationalizing user-centered ASRH models within government structures, even in a narrow time frame. A360 saw similar performance under government-led implementation and fidelity to the unique experience that the program was designed to deliver for adolescent girls. However, beginning this process earlier presents greater opportunities, as some aspects of the institutionalization process that are critical to sustained impact, for example, shifting government policy and measurement and mobilizing government resources, require heavy coordination and long-term efforts. Programs pursuing institutionalization in a shorter time frame would benefit from setting realistic expectations. This may include prioritizing a smaller subset of program components that have the greatest impact.
2018年至2020年期间，“青少年360”（A360）旨在提高15至19岁少女对现代避孕方法的需求并促使她们自愿采用，通过项目资助的扩展在坦桑尼亚13个地区设计并推广了一项干预措施（Kuwa Mjanja）。2020年，该项目开始为其后续阶段制定战略，重点是项目的可持续性。在此过程中，资助方的优先事项导致决定在15个月的退出期内停止A360在坦桑尼亚的项目。在此期间，A360选择推动Kuwa Mjanja快速融入政府体系。
在坦桑尼亚的17个地方政府机构中推动了融入政府体系的进程。收集并分析了定量和定性数据，包括对常规绩效数据的时间趋势分析、两轮客户退出访谈的统计分析以及定性研究的主题分析。
在政府主导实施下覆盖的少女的社会人口学特征与A360主导实施下覆盖的少女相当。在政府主导实施下，干预效率有所下降，但仍保持稳定。在政府主导模式下，采用的方法组合略有变化，更多地转向长效和可逆避孕方法的采用。促成Kuwa Mjanja成功融入政府体系的因素包括存在支持青年的政策、设立提供性与生殖健康教育的学校俱乐部、政府利益相关者的承诺以及将青少年怀孕视为一个问题。一些干预措施对项目效果很重要，但事实证明难以融入政府体系，主要原因是资源限制。缺乏以青少年性与生殖健康（ASRH）为重点的目标和指标不利于Kuwa Mjanja的实施。
即使在狭窄的时间框架内，在政府结构中实施以用户为中心的ASRH模式也具有巨大潜力。A360发现在政府主导实施下有类似的表现，并且忠实于该项目旨在为少女提供的独特体验。然而，更早开始这个过程会带来更多机会，因为对于持续影响至关重要的融入政府体系过程的某些方面，例如改变政府政策、测量和调动政府资源，需要大量协调和长期努力。在较短时间框架内寻求融入政府体系的项目将受益于设定现实的期望。这可能包括优先考虑对项目影响最大的较小部分的项目组成部分。
