Increasing youth access to family planning services using the pair-mentoring approach in the MAHEFA program areas

The program was implemented in six remote regions of north and north-west Madagascar from 2011 to 2016, with funding from USAID. The program was carried out in close collaboration with the Ministry of Public Health, the Ministry of Water, Sanitation and Hygiene, and the Ministry of Youth and Sport. The program trained a total of 6,052 community health volunteers (CHVs) to provide basic health services, including family planning and reproductive health, at the community level. The CHVs were selected by their own communities, supervised by heads of basic health centers, and provided services based on their scope of work as outlined in the National Community Health Policy. The work of the CHVs and other community actors involved with the MAHEFA program was entirely on a voluntary basis. Access to contraception, reproductive health information, and family planning services remains a global challenge, with an estimated 225 million women in developing countries having an unmet need for contraception. In Madagascar, the unmet need for family planning is highest among young people aged 10-24, with 27 percent of youth aged 15-19 having an unmet need for family planning. The MAHEFA program aimed to address this challenge by increasing access to family planning services among young people. The MAHEFA program used a mentoring approach between community health volunteers (CHVs) and youth peer educators (YPEs) to increase access to and utilization of family planning services among young people. The program worked in 24 districts, targeting youth in the capital communes of each district. The YPEs were trained to provide accurate information and refer youth who needed family planning services to CHVs or to government health facilities called Centres de Santé de Base (CSB). The program's key activities included selecting sites to establish YPE activities, identifying partners for the YPE activities, introducing YPE activities for local buy-in, assisting communes in selecting YPEs, conducting pre-service and refresher trainings for CHV mentors and YPEs, establishing a referral system between YPEs and CHVs or CSBs, and supporting YPEs to conduct family planning activities. The program also provided YPEs with job-aids and information education communication (IEC) materials to help them in their new roles as peer educators. The MAHEFA program's approach was innovative, pairing YPEs with CHV mentors to provide family planning education and services to youth in the target communes. The program's results showed a significant increase in access to family planning services among young people, with 64 percent of young women aged 15-24 years having given birth and 46 percent having done so before the age of 19 years. The program's success was attributed to the effective partnership between the MAHEFA program and local authorities, as well as the commitment of the community health volunteers and youth peer educators involved in the program.