Cathy Solter, SCM, MPH and Kathy Le, MPP PATHFINDER INTERNATIONAL 131st Annual Meeting and Exposition of the American Public Health Association San Francisco, CA November 17, 2003 Increasing Family Planning and Reproductive Health Access to Internally Displaced and Refugee Populations in Azerbaijan

131st APHA Annual Meeting and Exposition Background Information FACTS  Population: 7,771,092  Fertility Rate: 2.24  Abortion is legal  Lost 20% of territory (Nagorno-Karabakh region) to Armenia One million people have been displaced by the ten-year conflict with Armenia.

131st APHA Annual Meeting and Exposition AHAP in Azerbaijan Azerbaijan Humanitarian Assistance Program : six-year $45 million to support USAID's objective Reducing Human Suffering in Conflict Affected Areas Implementing Partners: ACDI/VOCA, Adventist Development and Relief Agency, Cooperative Housing Foundation, International Medical Corps, International Rescue Committee, Pathfinder International, Save the Children Federation, and World Vision. Pathfinder’s Program: Primary Health Care in Urban Areas (May 2001-July 2003)

131st APHA Annual Meeting and Exposition Increasing FP/RH Access at Community and Facility Levels Project Goal: To reach 90,000 internally displaced persons (IDPs) (70,000 women, 10,000 men and 10,000 adolescents )  Geographic Area: 29 IDP settlement areas in 13 districts in Baku, Apsheron, and Sumgait regions  800,000 IDPs live in the project areas  Ninety community- based service (CBS) workers with six supervisors  Trained 50 public sector service providers in FP/RH

131st APHA Annual Meeting and Exposition Accomplishments (1)  Community-based Services  88,562 people of reproductive age, including 62,142 women, 7,350 men and 19,070 adolescents  Increased use of modern contraceptives from 5,206 users to 12,906.  Decrease in the number of abortions from 1,603 to 507 in the three months prior to each survey. Contraceptive UseCondomsIUDPills 20036,6244,3861, ,4922,910757

131st APHA Annual Meeting and Exposition Accomplishments (2)  Training  90 CBS workers and six supervisors were trained in communication and FP/RH and adolescent health.  44 public sector service providers were given refresher trainings on FP/RH as well as maternal and child health, ARH, HIV/AIDS, and gender issues.  Environmental training was conducted for CBS workers as part of the Environmental Action Plan.  Dissemination and Coordination  Press releases, project bulletins, and newspaper articles  Sharing of IEC materials, such as leaflets and posters.

131st APHA Annual Meeting and Exposition Environmental Activities  Creation of an environmental action plan  Training for all CBS workers  4,000 information leaflets and 52 posters distributed  180 clean-up campaigns implemented

131st APHA Annual Meeting and Exposition Sustainability and Cost Recovery  Trained a group of 90 CBS workers and six supervisors who remain in the IDP communities.  CBS workers trained to measure blood pressure and apply first aid. Fees collected for services and proceeds used for training and equipping additional CBS workers.

131st APHA Annual Meeting and Exposition Knowledge, Attitude and Practices Baseline survey: October 2000 Final survey: July 2003 showed significant changes, examples:  Decrease in % of women who had never visited a gynecologist from 67.4% to 11.7%.  Percent of women giving birth in a maternity home or hospital increased from 53% to 96%.  Increase in the % of men who visited a doctor or urologist from 24.8% to 52.1%.  Substantial decrease in the rate of abortions among the target population from 1,603 to 507.  Pregnancy in survey group decreased from 45% to 38%.

131st APHA Annual Meeting and Exposition Frequency of Gynecological Visits by IDP Women

131st APHA Annual Meeting and Exposition HIV/AIDS and STI Knowledge Among IDP Women

131st APHA Annual Meeting and Exposition Knowledge of Contraceptive Methods Among IDP Women

131st APHA Annual Meeting and Exposition RH Knowledge Among IDP Adolescent Girls

131st APHA Annual Meeting and Exposition Constraints and Consequences Lack of resources for support and monitoring of public health service facilities and providers.  Impact: low wages for providers; poor incentive structure for the provision of quality services; insufficient materials and supplies; lack of logistics system.  Consequences: lack of contraceptives/supplies; providers charge extra fees for services; decreasing return visits by IDP clients.

131st APHA Annual Meeting and Exposition Lessons Learned  CBS activities must be accompanied by access to quality services in order to achieve maximum results.  The CBS approach is very effective in reaching IDP/refugees with FP/RH messages.  Gender inequality limits contraceptive use.  Increased use of modern contraceptive methods can contribute to a decrease in abortion rates.

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