1. page 1 Assessment of Gender Sensitivity in the Top Reseau Social Franchise Network Patricia NOROLALAO PSI Madagascar

2. Top Reseau Social Franchise - Launched in 2000 - 245 clinics: Urban: 67%, Peri-urban: 17%, Rural: 16% - 347 providers - 9 Services :  Basic package services : Youth reproductive health: RH, STI, FP Child survival, Fever Management  Optional package services : Long-acting reversible contraception HIV testing and counseling Cervical cancer screening Post-abortion care Nutrition

3. Why assess providers’ gender sensitivity? page 3  Gender norms and relations influence people’s ability to freely access family planning  50% of Women of Reproductive Age thought that husbands accept their wife using IUD

4. Objective of the Gender Assessment  Identify different constraints and opportunities that affect men and women’s health risks and capacity to seek appropriate quality care

5. Methodology Desk review: - PSI study - National documents/reports on gender - Gender assessment reports Interviews with 4 institutions - PSI STAFF, ISM Implementing partners - USAID funded project -Ministry of Health / Gender local stakeholders Focus Group Discussions with 93 people: - Unmarried men and women aged 15-24, with no living child - Married men and women with at least one child under 5 - Top Reseau providers, Supply points, CHW

6. Findings : 1- Health Care Providers  Providers' behaviors can have impact on the clients  For All : hidden contraceptive use “ The husband asked the wife ‘where are you going?’ She said [to the doctor] ‘if my husband checks tell him I’m not using. ’” – Urban Facility Based Provider  The majority of women in the FGD said, they have no provider sex preference “I don’t care as long as the doctor remains professional.” - Married Urban Woman

7. 2- Male and female friendly services Friendly services for all  Men and women, young singles and married people, all describe male and female friendly services in the same way Friendly services for married men  Comprehensive information for informed decision  Services tailored to their own needs and realities  Position men to communicate about health 7 “No one gives us information.” – Married Rural Man

8. Response to the findings  Reinforce and continue to assess in the quality assurance process the traits and behaviors clients value, including respect for privacy and confidentiality  Related to hidden contraception : support providers to identify and respond to Gender-Based Violence 8

9. Limitation and applicability  Qualitative programmatic assessment  Quality of care from client perspectives  Cost effectiveness

10. Thank you PAGE 10