Taking stock of existing barriers to sexual and reproductive health of girls and women in SSA and how collaboration and innovation can help shape the future

CAPE TOWN, SOUTH AFRICA - African Media Agency - 22 March 2024 - Africa has the highest rate of births to adolescent girls between the ages of 15-19 (99 births/1000 adolescents)^[1]. For years, women and girls have been failed by a fragmented, under-resourced health system that is not built to meet their sexual and reproductive health needs. The consequences are often devastating. Coupled with HIV, complications during pregnancy and childbirth are the leading cause of death for young women aged 15-19 years. In some countries, laws, policies, and social stigma prevent teenage mothers from returning to school, resulting in shattered dreams and lost potential.

"Tiko" which provides access to free reproductive health services that can change the course of many lives offering youth-friendly care and comprehensive information.

Within many of these communities lies a need for sexual and reproductive health services that are youth-friendly, safe, and conducted in a secure environment that provides accurate information and decision-making power to safeguard women and young girls well-being. An equally important consideration is cost – this is not merely through the lens of the cost of services, but also the burden of time that is placed on utilizing the services.

When women and girls have access to quality sexual and reproductive health services, and are equipped with the right knowledge, attitudes, and skills, they are better placed to make the right decisions, including when to marry, whether to use birth control and what kind, and how best to protect themselves and their partners from risks such as STIs including HIV and AIDs.

Disruption through innovation to drive real impact

Achieving universal access to sexual and reproductive health and rights by 2030 will require close collaboration by stakeholders in developing innovative solutions that can dismantle barriers to access among women and girls. No single entity can address the changing, complex challenges we encounter, which is why forging partnerships across sectors—governments, NGOs, private sector, and local communities—is pivotal. In Kenya, the Children's Investment Fund Foundation (CIFF), the United Nations in Kenya, the Government, and non-profit organization Tiko have collaborated to implement a development impact bond that aims to improve access to sexual and reproductive health information and services for adolescent girls, particularly those living in multidimensional poverty.

This focus on outcomes-based financing is a radical departure from traditional donor programming where every change or innovation is subject to lengthy approvals. By ensuring that healthcare systems are well-placed to provide quality sexual and reproductive health services through accountability mechanisms and incentive structures to reward certain quality standards, outcome-based financing mechanisms have great potential to increase the availability and accessibility of quality services to adolescents, young people, and women at large.

While services for the most vulnerable will always require some type of subsidy to be effective, sustainability is about ensuring that the mechanism for delivering these services is low-cost and effective to enable fuller lives. Apart from the focus on transformative change, outcome-based financing provides an opportunity to unlock new partnerships and incentivize non-traditional players to finance sexual and reproductive health, particularly with the continued dwindling of foreign aid.

Embracing technology to break down barriers.

Tech-based innovations can reduce costs and increase access, but more importantly, they can make services more responsive to the needs and desires of users. The successful implementation of the Development Impact Bond is largely powered by technology. The Tiko platform provides adolescent girls with easy access to health services, while at the same time allowing the program to be managed and adapted in real-time. As soon as a woman uses and reviews her service, a manager in Nairobi can see her feedback and adapt to ensure services stay at the highest standard. As service providers, Tiko and the health facility are only paid for services once it has been delivered, placing the incentives directly in her hands rather than in the control of a distant project designer.

The Tiko program involves all of these players, ensuring that the government's ambitions of reducing teenage pregnancy can be achieved through the nimbleness and responsiveness of a well-incentivized private and public health sector. Embracing collaboration also fosters learning and innovation through knowledge exchange and shared experiences to adapt to evolving needs and challenges.

By leveraging technology and community-based approaches, Tiko has overcome barriers such as geographic distance, cost, and stigma, ensuring that no girl is left behind. Through the platform, girls can access comprehensive information, counseling, and services tailored to their needs, empowering them to make informed decisions about their reproductive health.

A commitment to gender equality

Access to sexual reproductive health services is not just a matter of healthcare; it is a fundamental human right and a cornerstone of gender equality. By ensuring that women and girls have control over their bodies, reproductive choices, and health outcomes, we can unlock their full potential and contribute to broader social and economic development in sub-Saharan Africa.

Through innovation, collaboration, and adaptability, we can build a future where every woman and girl has the opportunity to lead a safe, healthy, and successful life. Together we believe that we can turn our aspirations into reality – a world where women and girls are enabled to do more.