ss

Evidence to Action for Strengthened Family Planning and Reproductive Health Services for
Women and Girls

Supporting Reproductive Health Services

for Young, First-Time Parents (FTP) in
Burkina Faso

Final Report
September 2020
About E2A

The Evidence to Action Project (E2A) is the US Agency for International Development’s (USAID) global
flagship for strengthening family planning and reproductive health service delivery. The project aims to
address the reproductive healthcare needs of girls, women, and underserved communities around the
world by increasing support, building evidence, and leading the scale-up of best practices that improve
family planning services. A Cooperative Agreement awarded in September 2011, E2A will continue until
September 2020. E2A is led by Pathfinder International in partnership with ExpandNet, IntraHealth
International, Management Sciences for Health, and PATH.

Contact Information
E2A Project
1015 15th Street NW
Suite 1100
Washington, DC 20005
Tel. 202-775-1977
Fax 202-775-1988
www.e2aproject.org

This publication was made possible through support provided by the Office of Population and
Reproductive Health, Bureau for Global Health, U.S. Agency for International Development, under the
terms of Award No. AID-OAA-A-11-00024. The opinions expressed herein are those of the author(s) and
do not necessarily reflect the views of the U.S. Agency for International Development.

2
Acronyms

ANC Antenatal care

CHW Community health worker

CPR Contraceptive prevalence rate

DHC District Health Committee

DHS Demographic and Health Survey

DSF Direction de la Sante de la Famille

E2A Evidence to Action Project

EMC Enquete Multisectoral Continue

EmONC Emergency obstetric and neonatal care

FP Family planning

FTM First-time mother

FTP First-time parent

HF Health facility

HTSP Healthy timing and spacing pregnancy

ICP Infirmier Chef de Poste

IPT Intermittent preventive treatment

IUD Intrauterine device

MCD Medicin Chef de District

MNCH/FP Maternal, Newborn, and Child Health/Family Planning

MoH Ministry of health

NGO Non-governmental organization

PNC Postnatal care

PPFP Postpartum family planning

3
RH Reproductive health

RMNCH Reproductive, maternal, newborn and child health

SRH Sexual and reproductive health

WHO World Health Organization

4
Acknowledgements
The E2A Project gratefully acknowledges the generous support of USAID and the Burkina Faso mission.

Special thanks are due to the Direction de la Santé de la Famille (DSF), the Ministry of Health (MoH), and
the Government of Burkina Faso for their continued collaboration on this project.

E2A also thanks the heads of the regional health directorates of the Center North and East regions, to
the Médecins Chefs de District (MCDs) of the districts of Kaya, Diapaga, Fada, Tougouri, Bogandé and
Manni, to the Infirmiers Chefs de Poste (ICPs) and Community Health Workers (CHWs) working in the
health areas of the various health facilities on the project sites, and to the mayors of the various
communes. Lastly, E2A thanks the hundreds of young first-time mothers, their partners, and mothers-in-
law who participated in the program for sharing their experiences and helping to advance programming
for young FTPs around the world.

It is our sincere hope that the work started on this project will continue and improve the health and
wellbeing of first-time parents, their families, and their communities.

5
Contents
...................................................................................................................................................................... 1
About E2A ................................................................................................................................................. 2
Acronyms .................................................................................................................................................. 3
Acknowledgements................................................................................................................................... 5
Executive Summary ................................................................................................................................... 8
Introduction .............................................................................................................................................. 9
Background ............................................................................................................................................... 9
Burkina Faso Health Context................................................................................................................. 9
Proposed Solutions and Technical Strategy ........................................................................................ 11
Project Goal and Objectives .................................................................................................................... 12
Phase 1 Goal and Objectives ............................................................................................................... 12
Phase 2 Goal and Objectives ............................................................................................................... 13
Geographic Scope ................................................................................................................................... 13
Phase 1 Geographic Scope .................................................................................................................. 13
Phase 2 Geographic Scope ................................................................................................................. 13
Key Interventions .................................................................................................................................... 14
Baseline Health Facility Assessments.................................................................................................. 14
Provider Capacity Building and Mentorship ....................................................................................... 14
Provision of Supplies and Tools to Health Facilities and CHWs .......................................................... 15
Monitoring of FP and Environmental Compliance .............................................................................. 16
Provision of Facility-Based Services to FTMs ...................................................................................... 17
Social Mapping/FTP Recruitment ....................................................................................................... 17
Peer Leader Selection and Training .................................................................................................... 20
First-Time Mother Peer Groups .......................................................................................................... 21
Outreaches with Husbands of FTMs ................................................................................................... 22
Outreaches with Mothers-in-Law of FTMs ......................................................................................... 23
Joint FTP Couple Sessions ................................................................................................................... 24
Home Visits ......................................................................................................................................... 24
Engagement with Government and Collaboration with Other Partners/Stakeholders ..................... 26
Results ..................................................................................................................................................... 26
Phase 1 Result Highlights .................................................................................................................... 27

6
 Phase 2 Result Highlights .................................................................................................................... 29
Lessons Learned ...................................................................................................................................... 31
Challenges ............................................................................................................................................... 32
What Worked to Mitigate these Issues .............................................................................................. 32
ANNEXES ................................................................................................................................................. 34
Annex 1: Villages, districts, and intervention areas covered by phase 1 of the project .................... 34
Annex 1: Villages, districts, and intervention areas covered by phase 2 of the project .................... 36

7
Executive Summary

The E2A project received field support funding from USAID Burkina Faso mission to implement a project
aimed to increase access and use of quality maternal, newborn, and child health/family planning
(MNCH/FP) services among first-time parents (FTP)—adolescents and young women under the age of
25, married or unmarried, who are pregnant or have a child that is younger than two years old, and their
partners. The Youth project was implemented in two phases, which combined spanned from March
2018-June 2020. The project worked at the facility- and community-levels in the East and Center North
regions of Burkina Faso, which are marked by high frequency of early marriage and childbearing as well
as poor MNCH/FP outcomes for young mothers.

The project included a package of interventions, including: provider capacity building and mentorship,
support to health facilities and community health workers, peer-led small groups with first-time mothers
(FTM), small groups with FTMs’ husbands, joint couple sessions bringing together FTMs and their
husbands, informational sessions with mothers-in-law of FTMs, home visits for the benefit of FTMs and
members of their household, and collaboration with the government and coordination with other
partners and stakeholders.

The first phase of the project saw some promising results, including an increase in the percentage of
women that had given birth who had received at least 4 antenatal care (ANC) visits—from 59.3% at
baseline to 66% at endline. Program participants also reported increased awareness of ANC, including the
importance of using services early in pregnancy, as well as improved healthy timing and spacing of
pregnancy (HTSP) knowledge and attitudes among FTMs and their husbands. Based on these promising
results—and building upon the lessons learned from the first phase—the second phase of FTP
programming was implemented with the addition of new topics and revised approaches. The second
phase of the project was also able to demonstrate some strong results, including improvements in early
initiation of breastfeeding among program participants, which increased from 53.3% at baseline to 91.3%
at endline. Contraceptive use also increased substantially from baseline to endline, rising from 18.9% to
45.7% during this period.

The Youth project also provided some important lessons learned to inform future programming:
• The FTM peer groups could be continued by the MoH through the establishment of longer-term
health clubs, building upon the capacity built by the project and providing further opportunities
to meet the needs of these young first-time mothers.
• Inclusion of an income-generating activities component in the package of interventions for young
first-time mothers would contribute to their empowerment.
• Given the importance of the target, considering this group as a specific group within the
adolescent and youth programs would help to better prioritize the needs of FTPs.

The project was implemented with the full involvement of the MoH, local governments, and the
communities themselves, which has led to capacity building at a number of levels and will allow for the
continuation of key services and interventions, even after the project has ended.

8
Introduction

The Evidence to Action Project (E2A) is USAID’s global flagship project for strengthening family planning
and reproductive health service delivery. The E2A project received field support funding from USAID
Burkina Faso mission to implement a project in the East and Center North regions targeting first-time
parents (FTP)—adolescents and young women under the age of 25, married or unmarried, who are
pregnant or have a child that is younger than two years old, and their partners.

In designing the RISE-FP project, E2A and Pathfinder applied three key principles: (i) alignment with the
objectives of the Ministry of Health, (ii) reinforcement of the health system (focused on the district
level), and (iii) complementarity with other partners, funded by USAID or other donors.

The project was implemented in two phases. The first phase of the project was implemented between
March 2018-June 2019 in the Fada and Diapaga Health Districts of the East Region with the goal of
increasing family planning (FP) uptake and the use of Reproductive, Maternal, Neonatal, and Child
Health (RMNCH) care—especially antenatal care (ANC) and obstetric and neonatal services—among
FTPs. The project worked at both the facility and community level in 20 health facilities and 57
surrounding villages. After the initial 15 months of implementation, USAID granted an extension to
implement a second phase of the project between July 2019-June 2020 in five health districts across the
East and Center North regions of Burkina Faso. Based on the results and learnings of the first phase of
the project, and in consultation with USAID, the second phase was implemented in 20 health facilities
and 20 surrounding villages with the goal of increasing access to and use of quality MNCH/FP services
for first-time parents and their children.

Both phases of the project aligned with key national policies and strategies including: the Burkina Faso
Costed Implementation Plan, the National FP Acceleration Plan, the Universal Health Coverage strategy,
and the policy providing free healthcare to pregnant women and young children. The project worked in
close collaboration with the MoH at both the central level with the DSF (Health and Family Directorate)
as well as the decentralized health district level. The project was introduced to the district management
team, representatives of local authorities, administrative authorities, and representatives of youth and
women's organizations in the project areas, and project activities were integrated into the annual action
plan of the health districts. The project also held quarterly program review meetings with the DSF to
review project progress and ensure alignment with the Directorate’s goals and initiatives.

Background

Burkina Faso Health Context

The East and Center North regions of Burkina Faso are characterized by high frequency of early marriage
and childbearing as well as poor RMNCH and FP outcomes for young mothers. In these regions, sexual
debut is early and generally occurs within the context of marriage, and the interval between marriage
and first birth is relatively short. According to the 2010 Burkina Faso Demographic and Health Survey
(DHS), the median age of marriage for women is 17.2 years old in the East region and 17.9 years old in

9
the Center North region, and the median age at first birth is 18.4 and 19.7, respectively 1. These two
regions also have amongst the highest total fertility rates in the country at 7.5 children per woman in
the East Region and 6.7 children per woman in the Center North Region 2. Furthermore, contraceptive
use in these two regions is low and unmet need for family planning is high, at 23.1% (East) and 20.0%
(Center North) 3. Given early childbearing, it is also important to note that national levels of
contraceptive use by younger women are particularly low, with just 5.9% of adolescents aged 15–19
years using a modern contraceptive method 4. Furthermore, utilization of antenatal care services
nationally is poor, with only 33.7% of women receiving at least four antenatal care visits and only 41.2%
of women receiving at least one antenatal care visit within the first four months of pregnancy 5. While
the 2014 Burkina Faso Enquete Multisectorielle Continue (EMC) shows some improvements in early
marriage and childbearing, as well as modern contraceptive prevalence rate (mCPR) and unmet need,
these broader health concerns persist, and the East and Center North regions continue to lag behind the
country as a whole 6.

In addition to the health issues presented above, FTMs face unique challenges that limit their
reproductive health choices and actions—challenges that are different from other adolescents and
different from older married women. In the Eastern Region and in Burkina Faso generally, childbearing
typically occurs within the context of marriage. Early marriage and the expectation to begin childbearing
shortly thereafter can put adolescent girls at a disadvantage by limiting their mobility and isolating them
from supportive social networks 7. Furthermore, even if they have access to reproductive health services,
young women and girls often must get permission from their husbands and other household influencers
to visit the health center or obtain services 8. Unequal power and gender dynamics, along with other
factors such as socio-cultural preferences around fertility and health provider bias, can fuel early, rapid,
and repeat pregnancies, compromising the health of young women and their newborns. These early or
closely spaced pregnancies pose significant risks for young FTMs. Pregnant adolescents are at increased
risk for multiple adverse health consequences for both the mother and child. Young women who
become pregnant during their teenage years are at an increased risk of developing eclampsia, puerperal
endometritis, systemic infections, and maternal death; and children born from adolescent mothers have
increased risks of low birth weight and premature birth, which contribute to early neonatal death 91011.

1
Institut National de la Statistique et de la Démographie (INSD) et ICF International, 2012. Enquête
Démographique et de Santé et à Indicateurs Multiples du Burkina Faso 2010. Calverton, Maryland, USA : INSD et
ICF International.
2
Ibid.
3
Ibid.
4
Ibid.
5
Ibid.
6
INSD, Rapport du Module Démographie et Sante (MDS) de l’Enquête Multisectorielle Continue (EMC), 2015
7
Anna Engebretsen and Gisele Kabore, Addressing the needs of girls at risk of early marriage and married
adolescent girls inBurkina Faso (Population Council, May 2011)
8
Ibid.
9
Ganchimeg, T., E. Ota, N. Morisaki, M. Laopaiboon, P. Lumbiganon, J. Zhang, B. Yamdamsuren, M. Temmerman, L.
Say, and Ö. Tunçalp. 2014. “Pregnancy and Childbirth Outcomes among Adolescent Mothers: A World Health
Organization Multicountry Study.” BJOG: An International Journal of Obstetrics & Gynaecology 121(s1):40-48.
10
Chen, X.K., S.W. Wen, N. Fleming, K. Demissie, G.G. Rhoads, and M. Walker. 2007. “Teenage Pregnancy and
Adverse Birth Outcomes: A Large Population Based Retrospective Cohort Study.” International Journal of
Epidemiology 36(2):368
11
Conde-Agudelo, A., J.M. Belizán, and C. Lammers. 2005. “Maternal-perinatal Morbidity and Mortality Associated
with Adolescent Pregnancy in Latin America: Cross-sectional Study.” American Journal of Obstetrics and
Gynecology 192(2):342-349.

10
Proposed Solutions and Technical Strategy
Most maternal deaths are preventable, as the healthcare solutions to prevent or manage complications
are well known. To improve maternal health, the World Health Organization (WHO) states barriers that
limit access to quality maternal health services must be identified and addressed at all levels of the
health system. Skilled care before, during, and after childbirth can save the lives of women and newborn
babies. The WHO recommends: 1) ensure universal health coverage for comprehensive reproductive,
maternal, and newborn health care; 2) address all causes of maternal mortality, reproductive and
maternal morbidities, and related disabilities; and 3) strengthen health systems to collect high-quality
data to respond to the needs and priorities of women and girls.

All women need access to ANC including intermittent preventive treatment (IPT) of malaria in
pregnancy, skilled care during childbirth, and support in the first few weeks after childbirth. Poor
women in remote areas are the least likely to receive adequate health care. This is especially true for
regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia. Safe
delivery by a skilled birth attendant and strong neonatal care are essential to bring immediate attention
to breathing and warmth, hygienic cord and skin care, and early initiation of exclusive breastfeeding.

Overall, the project aimed to support the Burkina Faso MoH in the provision of FP and MNCH services to
young women and men. The Burkina Faso MoH routinely provides maternal and child health care
through health facilities. The project reinforced health facilities’ capacity for service provision through
training, equipment, supervision, and leveraging CHWs to reach beneficiaries in remote areas. The MoH
identified two CHWs in each village for basic health services management, and the project worked with
these same CHWs. The project aimed to strengthen family planning and reproductive health (FP/RH)
service delivery, focusing on the needs of FTPs. The project interventions were designed using
innovative and complementary approaches based on the E2A/Pathfinder sexual and reproductive health
(SRH) Lifestages Framework.

The SRH Lifestages Framework lays out a normative progression of sexual and reproductive activity
across an individual’s lifetime and builds a layered understanding of that individual as s/he moves
through SRH lifestages, transitions, and milestones. This framework uses three ‘layers’ to analyze and
contextualize the specific SRH needs and situation of an individual at any lifestage:
1. SRH Markers – Defines key sexual and reproductive events that occur across an individual’s
lifetime. While primarily intended to focus on health markers, this can include related life
events that affect SRH risks or activity, such as marriage or leaving school.
2. Socio-Ecological Factors – Defines the different people and systems that directly or
indirectly influence an individual’s SRH situation, using the familiar socio-ecological concept.
3. Relational Dynamics – Defines the varied interactions and social/gender factors that affect
an individual’s agency and ability to navigate through SRH lifestages.

When designing the first phase of the Youth project, E2A and Pathfinder applied the first layer of the
SRH Lifestages Framework to depict the SRH lifestages of women in the East region of Burkina Faso.
Drawing on available data, the framework highlights the rapid sequence of life events that shape a
young women’s transition from the pre-sexual activity lifestage to the lifestage of sexual and
reproductive activity. While not necessarily true for all women, the data suggests that the first year
after marriage is often the catalyst for young married women to experience their first sexual activity,
pregnancy and childbirth.

11
SRH Lifestages of Women in East Region, Burkina Faso

From a programming standpoint, this figure highlights the opportunity for interventions that aim to
influence RMNCH outcomes. Although the interval between marriage and first pregnancy is short, it is a
strategic opportunity to work with newly married women/couples on healthy timing and spacing of
pregnancies (HTSP) and planning for safe pregnancies and birth of their first children. Understanding
that social and gender norms stress early childbearing within marriage, there is also the potential to
work with young women and their families after they have had their first child to shape their
subsequent childbearing. E2A and Pathfinder also set out to address child health outcomes through the
implementation of the two phases of the FTP project.

Project Goal and Objectives

Phase 1 Goal and Objectives
The first phase of the project was implemented between March 2018-June 2019 in the Fada and
Diapaga Health Districts of the East Region with the following goal and objectives:

Overall Project Goal

Increase access to and use of quality maternal, newborn and child health/family planning services for
first-time parents and their children in the East and Center North regions.

Project Objectives

Strategic Objective 1: Increase FTP access to and utilization of clinical antenatal/postnatal (ANC/PNC),
delivery services, newborn care and FP

Strategic objective 2: Increase demand among FTPs for RMCNH care, facility-based delivery, healthy
timing and spacing of pregnancy (HTSP), and FP

12
Strategic objective 3: Create a friendly environment for FTP health action among household and
community influencers, including health providers

Phase 2 Goal and Objectives

The second phase of the project was implemented between July 2019-June 2020 in five health districts
across the East and Center North regions of Burkina Faso. Based on the results and learnings of the first
phase of the project, and in consultation with USAID/Burkina Faso, the second phase established the
following goal and objectives:

Overall Project Goal

Increase access to and use of quality maternal, newborn and child health/family planning services for
first-time parents and their children in the East and Center North regions.

Project Objectives

Strategic Objective 1: Increase access to clinical MNCH care focusing on FP/postpartum FP (PPFP) for FTP
peer group participants

Strategic objective 2: Increase demand among young women, with a focus on first-time mothers, for
FP/PPFP and MNCH services and related health behaviors, such as exclusive breastfeeding

Strategic objective 3: Create an enabling environment in the project zone for FP uptake and utilization of
MNCH services and ensure sustainability of services.

Geographic Scope
Phase 1 Geographic Scope
Phase 1 of the E2A Youth Project in Burkina Faso was
implemented in the Fada and Diapaga Health Districts of the
East Region. The project covered 20 health facilities and 57
surrounding villages across these two regions. The project
prioritized rural and semi-urban facilities and used several
baseline indicators, such as the number of deliveries, the size
of the population, the security situation, and accessibility to
select high-volume facilities that would most benefit from
project support.

Phase 2 Geographic Scope

For Phase 2 of the Youth project, E2A and Pathfinder, in consultation with USAID/Burkina Faso, selected
20 health facilities and 20 surrounding villages in five districts across the East and Center North regions

13
of Burkina Faso. The five districts covered by the project include: Fada, Bogande, and Manni in the East
region and Kaya and Tougouri in Center North. The project was able to capitalize on provider and health
system capacity that was previously built through Phase 1 of the Youth and RISE-FP projects by selecting
to work in districts and facilities that were already covered by these projects. Furthermore, the project
locations were selected based on the context/needs as well as logistical considerations, such as the local
security situation. Population size and accessibility were also determinants in the choice of intervention
sites.

Key Interventions
The Youth project was initially approved in March 2018 for one year of implementation. The program
was then extended through June 2020. Over the two years of implementation, the following key
interventions were implemented:

Baseline Health Facility Assessments

At the beginning of Phase 1, the project conducted an assessment of the project-supported health
facilities in the Fada and Diapaga health districts in order to obtain updated baseline data on all project
health facilities and their area of coverage. The general objective of the baseline assessment was to
describe the availability of reproductive, maternal and neonatal health services, including family
planning, with a view to strengthening the operational capacities of health facilities. Specifically, the
baseline assessment:

• Assessed the availability of medico-technical equipment for the provision of reproductive,

maternal and child health services including FP;
• Assessed the training needs of providers in the health facilities;
• Identified intervention villages and CHWs in the intervention zone;
• Collected data on current reproductive, maternal and child health indicators.

For the second phase of the project, which was extended to the health districts of Bogandé, Manni,
Tougouri, and Kaya, a second assessment was not conducted, because all of the health facilities were
assessed (using the same tool) during Phase 1 of either the Youth or RISE-FP projects implemented by
E2A in the East and Center North regions.

The findings of the baseline assessment of the health facilities mainly revealed a lack of equipment to
offer certain contraceptive methods, particularly the intrauterine device (IUD) and the contraceptive
implant. Also, some providers did not have a good understanding of IUD and implant methods. In
addition, there were shortcomings in infection prevention and in the quality of data collected. These
findings were noted for the project to address during implementation.

Provider Capacity Building and Mentorship

Beginning in September 2018, the project conducted a series of training sessions on emergency obstetric
and neonatal care (EmONC) and FP for 69 providers from the 19 basic health facilities included in phase 1
of the Youth project, with the involvement of gynecologists from the CHR in Fada (the 20th facility). For
phase 2 of the project, no new trainings were conducted as the providers had previously been trained
through either the Youth or RISE-FP E2A projects.

14
Throughout phase 1 and phase 2 of the Youth project, providers in the project-supported health facilities
received monthly clinical mentorship by Pathfinder mentor-trainers as well as quarterly supportive
supervision conducted by Pathfinder mentor-trainers alongside representatives from the health districts.
The mentorship approach employed by the project involved identifying the skill-improvement needs for
each provider, developing a field visit plan, and conducting ongoing mentorship to improve the providers’
skills for quality clinical service provision.

During the start-up of both phases, CHWs, who were already working under the MoH, were identified and
trained on communication and counseling approaches and how best to reach FTMs and their key
influencers. The training used the MoH’s official CHW training curriculum, with the addition of FTP-specific
materials related to project activities. While CHWs were directly supervised by their facility-based
supervisors, Pathfinder staff provided them with monthly coaching and quarterly joint supportive
supervision in collaboration with the nurse in-charges at the facilities.

Provision of Supplies and Tools to Health Facilities and CHWs

During the health facility assessment conducted at the beginning of the E2A Youth and RISE-FP projects,
the project discovered that on average the project-supported facilities were lacking in the following
essential supplies:
• Medical-technical supplies
• Implant and IUD insertion and removal kits
• Maternal and child health record adapted for data collection
• CHW animation kits
To support the health facilities, the project equipped 20 health facilities with basic medical technical
supplies and IUD and implant insertion and removal kits. The project also provided 113 CHWs with
bicycles and animation kits and provided program participants with the Mother and Child health record.

15
 Photo: Delivery of medical equipment to the MOH

Photos: Bikes provided to CHWs to better enable them to travel to complete project activities

Monitoring of FP and Environmental Compliance

FP and environmental compliance monitoring was carried out by Pathfinder staff during the two years of
project implementation. Compliance monitoring was integrated into supervision visits, and annual
assessments of FP and environmental compliance were conducted for all project-supported health
facilities.

16
Provision of Facility-Based Services to FTMs
Through provider capacity building, as well as the provision of supplies, the project’s aim was to ensure
that the project-supported health facilities were equipped and trained to provide quality healthcare to
young women and first-time parents, with a specific focus on:
• Systematic FP counseling for women who arrive at the health facility for pre- and post-natal care
or who have been referred by CHWs to the facility
• Provision of FP services (counseling and methods) to young women in the post-abortion period
• Provision of FP services to young women under 25 years of age who already have a child

Social Mapping/FTP Recruitment

Prior to the start of the FTM peer groups and other community-based interventions, the project
conducted a social mapping exercise to identify FTMs in the project villages. The social mapping exercise
was conducted in close coordination with locally based CHWs who were known resource persons in the
community and trained and paid by the Burkina Faso MoH. The primary purpose of the social mapping
exercise was to develop a list of potential program beneficiaries that met the project’s recruitment
criteria: young women (married or unmarried) residing in the identified project villages under the age of
25 who are pregnant for the first time or have one child under 24 months of age. In most cases, staff
and CHWs first met with the entire household to inform them of the project and gain support for
participation from FTMs, their husbands, and their mothers-in-law. Once the household was informed of
the program, the project staff enrolled FTMs individually and collected basic baseline health data. By
providing a sense of the potential pool of FTM participants, the mapping exercise helped define the final
set of community- and facility-based interventions included in the FTP project.

Specifically, the social mapping exercise allowed the project to:

• Develop a database of young FTMs for program participation and individual-level follow-up for
provision and tracking of RMNCH services
• Identify households, partners and peer leaders
• Estimate key project indicator targets

For the Phase 1 program, the social mapping activity was carried out in 60 villages in the health districts
of Fada and Diapaga. A total of 853 FTPs were identified with the support of 113 CHWs. To tailor home
visits to individual needs and monitor lifestage-specific interventions more effectively, participants
identified through the phase 1 social mapping exercise were classified into one of three segments based
on their status at the time: Segment 1: 0–3 months pregnant; Segment 2: 4–9 months pregnant; and
Segment 3: has one child under 24 months of age.

17
Table 1: FTPs Identified during the Social Mapping Exercise, Phase 1

# of smalls

Seg 1

Seg 2

Seg 3

lFTPs
tota
VILLAGES
groups
TOTAL MAPPED 60 67 157 629 853
# excluded* 3 1 1 8 10
# included 57 66 156 621 843 67

For the Phase 2 program, the social mapping activity was carried out in 20 villages in the health districts
of Fada, Bogande, Kaya, Tougouri and Manni. These five health districts are divided into the three
project zones outlined below (Fada, Bogande, and Kaya). A total of 296 FTMs, 284 husbands, and 290
mothers-in-law were identified by the project with the support of 40 project-trained CHWs. For this
second phase, FTMs were no longer divided into 3 segments, but rather identified as either pregnant or
having one child under the age of two. The project also put increase emphasis during this second phase
on identifying and collecting baseline data on key influencers (husbands and mothers-in-law) along with
the first-time mothers. The phase 2 social mapping tool was also revised to add some knowledge,
attitudes, and behavior questions related to key health actions, with the intention of asking these
questions again at endline 12.

Table 2: FTPs, Spouses, Mothers-in-law and Peer Leaders by Project Area, Phase 2

Zone FTPs Spouses Mothers-in-law FTPs Mother

Leaders

Fada 103 94 97 16

Bogande 90 88 90 12

Kaya 103 102 103 12

Total 296 284 290 40

12
Refer to the challenges section for an explanation on the status of the endline data collection

18
 Photos: social mapping in the villages of Fada

Photos: social mapping in the villages of Bogandé

19
Peer Leader Selection and Training
FTM peer leaders were selected from the group of FTMs identified during the social mapping exercise
and were tasked to lead the FTM small group discussion sessions for their peers. FTM peer leaders (for
both phases) were identified, with the assistance of CHWs, using the following criteria:

• Being an FTM from the village where the group is implemented;

• Being available, dynamic and accepted by the other FTMs;
• Being committed to essential newborn care and family planning services;
• Having strong communication skills;
• Having the capacity to mobilize their peers;
• Knowing how to read and write in French is an asset.

A total of 172 peer leaders, 132 from phase 1 and 40 from phase 2, were given a three-day training
focused on Essential Newborn Care/Family Planning and the use of activity cards to facilitate the small
group discussion sessions.

Photos: Training of peer leaders

20
The role of the peer leaders included mobilizing FTMs for participation in the peer group sessions;
directing FP clients to the CHWs for counseling, services, and referrals; and facilitating the FTM small
group sessions using the project-developed activity cards.

First-Time Mother Peer Groups

FTM peer groups were a central activity for the Youth project. Peer groups were led by young women
peer leaders, and at least one CHW attended each session to support the peer leaders in facilitation,
provide health information, provide referrals or services to peer group members, and track peer group
member participation. The peer groups comprised young FTMs, including pregnant and postpartum
FTMs, and ranged from 8–15 members each. The groups gathered twice a month to discuss a selected
topic, using the activity cards—some of which were adapted from the GREAT 13 project and others that
were developed by E2A—as a guide.

For phase 1, the peer group intervention was implemented in the 57 project-supported villages (12 in
Diapaga, 45 in Fada), and a total of 67 peer groups were active over a five-month period (January–May
2019). Ten peer group sessions were planned, and during each session the group could select which of
the 11 available activity cards to cover. The activity card topics for phase 1 included:

ACTIVITY 1: PRE-NATAL CONSULTATION AND DANGER SIGNS DURING PREGNANCY.

ACTIVITY 2: PLANNING AND IDEAL SPACING OF PREGNANCIES FOR HEALTH.
ACTIVITY 3: ROLE OF MEN AND WOMEN.
ACTIVITY 4: REPRODUCTIVE HEALTH CHOICES
ACTIVITY 5: EXCLUSIVE BREASTFEEDING.
ACTIVITY 6: INJECTABLE CONTRACEPTIVE: TRUE OR FALSE
ACTIVITY 7: COMBINED ORAL CONTRACEPTIVES: TRUE OR FALSE
ACTIVITY 8: STERILET: TRUE OR FALSE
ACTIVITY 9: CONDOMS: TRUE OR FALSE
ACTIVITY 10: IMPLANTS: TRUE OR FALSE
ACTIVITY 11: MAMA: TRUE OR FALSE

During Phase 1,10 sessions were conducted during the implementation period.

For phase 2, a total of 20 peer groups were active over a four-month period (December 2019–March
2020). The project revised previous activity cards and created new ones to develop a package of 10
activity cards that were sequenced to align with topics discussed in the husband’s and mothers-in-law
sessions. The topics of the revised activity cards include:

ACTIVITY 1: PRE-NATAL CONSULTATION AND ASSISTED CHILDBIRTH

ACTIVITY 2: DANGER SIGNS DURING PREGNANCY
ACTIVITY 3: HEALTHY TIMING AND SPACING PREGNANCY (HTSP)
ACTIVITY 4: OVERVIEW OF FP METHODS

13
The Gender Roles, Equality and Transformations (GREAT) project was led by the Institute for Reproductive
Health of Georgetown University and implemented by Pathfinder International and Save the Children in Northern
Uganda.

21
ACTIVITY 5: ROLE OF MEN AND WOMEN
ACTIVTY 6: IMPLANTS - TRUE OR FALSE
ACTIVTY 7: TALKING ABOUT DIFFICULT TOPICS
ACTIVITY 8: MAKING HEALTHY DECISIONS
ACTIVITY 9: INJECTABLE CONTRACEPTIVE: TRUE OR FALSE
ACTIVITY 10: INFANT AND YOUNG CHILD FEEDING (IYCF)

Unfortunately, only the first 7 of the 10 planned sessions were completed in phase 2 due to the
suspension of community-based activities during the COVID-19 pandemic.

Photos: FTM small groups discussions

Outreaches with Husbands of FTMs

During Phase 1, discussion sessions with the husbands of FTMs were held once per month, for a total of
five sessions (January–May 2019). The men were initially invited by the participating FTMs, and all who

22
were interested were able to participate in discussion groups—with an average of 8 men per group. The
purpose of these meetings was to raise awareness about young women’s access to critical health
services during the FTP lifestage. CHWs, with support from Pathfinder staff, conducted group
discussions using MoH counseling tools and Pathfinder’s Pathways to Change game 14. The game was
used to identify barriers and facilitators to adopting key health- and gender-related behaviors that were
then discussed as a group. The sessions focused on three key topics: men’s and women’s roles,
reproductive choices, and ANC.

In Phase 2, three discussion sessions were held with the husbands of FTMs between December 2019-
February 2020. During this second phase, Pathfinder staff conducted these sessions using project-
adapted/developed activity cards, covering the following topics:

SESSION 1: LOW-RISK PREGNANCY AND ASSISTED DELIVERY

SESSION 2: HEALTHY TIMING AND SPACING PREGNANCY (HTSP)
SESSION 3: EXPLORING GENDER

Given the challenges engaging men experienced during the first phase due to competing work priorities,
this phase focused on strategic health gaps/concerns, especially those that touch on deeply held cultural
and gender norms. The husband sessions during this phase were also timed to coordinate with the FTM
discussion sessions, to encourage household communication on these topics. Due to COVID-19, the final
session covering gender roles was not able to be completed.

Outreaches with Mothers-in-Law of FTMs

In Phase 1, discussion sessions with the mothers-in-law of FTMs (and other older women who were key
influencers of FTM peer group members) were held once per month, for a total of five sessions
(January–May 2019). The first invitation to the mothers-in-law was sent through the participating FTMs,
and the sessions had on average nine mothers-in-law per group. For these sessions, CHWs—with
support from Pathfinder supervisors—used MoH tools to lead discussions on thematic topics around
ANC, safe delivery, and postpartum family planning with the objective of encouraging mothers-in-law to
support young women’s access to services.

For Phase 2, three discussion sessions were held with the mothers-in-law of FTMs (and other older
women who were key influencers of FTM peer group members) between December 2019-February
2020. These sessions were facilitated by CHWs, with support from Pathfinder supervisors. While the first
mothers-in-law sessions in the first phase used MOH tools to lead discussions on thematic topics around
ANC, safe delivery, and postpartum family planning, activity cards were developed for this second
phase, covering the following topics:

INFORMATION SESSION I: PREGNANCY AND ASSISTED CHILDBIRTH.

INFORMATION SESSION 2: HEALTHY TIMING AND SPACING PREGNANCY (HTSP)

14
The Pathways to Change game is a behavior change tool in the form of a simple game that is designed to identify
barriers and facilitators to change and generate discussion and stimulate thinking that can motivate individuals and
communities to change

23
INFORMATION SESSION 3: INFANT AND YOUNG CHILD FEEDING (IYCF) AND INFANT HEALTH

As with the men’s sessions, the topics with the mothers-in-law focused on strategic health concerns
that involve deeply held cultural norms in order to encourage mothers-in-law to support young
women’s access to services. These sessions were also timed to correspond with FTM and husband
discussion sessions to encourage household communication.

Joint FTP Couple Sessions

Based on the implementation experiences of the phase one FTP program, as well as E2A’s interest in
exploring the potential for couple-focused interventions within the FTP framework, a new intervention
component was added to the phase two program—joint couple sessions bringing together FTMs and
their husbands to discuss key health topics. The project planned the following two Pathfinder staff-led
sessions:

JOINT SESSION 1: THE FIRST ANC

JOINT SESSION 2: HEALTHY TIMING AND SPACING PREGNANCY (HTSP)

Due to COVID-19 only the first joint session (discussing ANC) was able to be completed.

Home Visits
Across the two phases of the project, 153 Community-Based Health Workers were trained on maternal,
neonatal and child health and family planning issues in order to carry out home visits for FTPs and
members of their household. The CHWs were coached by the project staff and under the supervision of
the health facility managers. In their MoH role, CHWs typically conduct home visits with women during
pregnancy and the immediate post-partum period. The home visits during pregnancy focused on:
encouraging early initiation of ANC and attendance of at least four ANC visits; helping the family prepare
for delivery at a health facility; ensuring the pregnant women is sleeping under a treated mosquito net;
and encouraging continued use of prescribed treatments (iron, antiretrovirals, etc.). Home visits during
the postpartum period included: assessing the newborn and mother for danger signs; encouraging
exclusive breastfeeding and good infant care practices; reminding the mother to go for her postnatal
care visit; monitoring the weight and health of the infant; and counseling on FP. During these home
visits, they typically provide, among other services, referrals to the health facility for ANC, risk
assessments, FP, and other services as well as community-based refills of some short-term FP methods
such as pills and condoms. For this FTP program, CHWs were encouraged to ensure that all enrolled
FTMs received the standard MOH home visits as well as additional visits throughout the FTP lifestage
period, based on the needs of the individual FTM. Through the home visits, CHWs were also able to
reinforce messages that were raised during peer group discussions.

24
25
 Photos : Home visits

Engagement with Government and Collaboration with Other Partners/Stakeholders

The project is committed to supporting the actions of the Ministry of Health alongside other actors. To
that end, the project collaborated with the government, implementing partners, and other key
stakeholders on a number of important activities, including:
• Participation in the various national family planning weeks held twice a year. This participation
took place at the national level and at the health district level.
• Support for the holding of four District Health Committees (DHCs) in collaboration with PSM,
another USAID-funded project.
• Participation and integration of project activities in the action plan of the health districts.
• The presentation of the project during the sessions of some municipal councils and to the
regional health and administrative authorities.
• Initiation of monthly consultation frameworks in order to improve collaboration,
communication and complementarity in the planning and implementation of the action plans of
the FP partners financed by USAID.
• Monthly review and accountability meetings at the DSF.
• Participation in advocacy actions with other actors for the effectiveness of free FP services in
Burkina Faso.
• Support to the Ministry of Health through the renovation of the DSF, the provision of internet
and the provision of an administrative assistant to the Ministry of Health.

Results
The Youth project provided a unique opportunity to work with young FTMs and their key influencers
across the FTP lifestage—from those just starting their first pregnancy, through to two years post-
partum. This allowed the project to address a wide range of FTP health issues, including ANC, HTSP/FP,
and exclusive breastfeeding, among others. As mentioned previously, the Youth project was divided into
two phases with the initial phase being conducted in two districts in the East region between March

26
2018-June 2019 and the second phase being conducted in five districts across the East and Center North
regions between July 2019-June 2020. This results section will be divided by phase.

Phase 1 Result Highlights

During the first phase, the project trained 69 providers from the project’s health facilities on EmONC/FP.
This, coupled with the continued mentorship and supportive supervision provided to the trained facility-
based providers and project-supported community health workers, helped strengthen service delivery in
the project areas, ensuring that FTMs and other young women are able to access high-quality youth-
friendly services.

Monitoring data from the FTP peer groups also indicated that the program was able to attract and retain
FTMs at different stages of their FTP experience and across key demographic characteristics. When
comparing enrolled program participants with those that attended at least 5 sessions and had at least
one home visits, the demographic profiles are generally similar showing that pregnancy status, age, or
education level did not pose a significant barrier to participation.

Table 3: Demographic characteristics of enrolled FTMs vs those that attended at least 5 peer group
sessions and received at least one home visit

27
One key health service of interest to the project was facility-based assisted delivery. During the first
quarter of project implementation after FTP enrollment (Oct-Dec 2018), there were 7 recorded home
births, however, no home births were observed over the remainder of the implementation period. This
points to the project’s ability—through peer groups and interactions with CHWs and facility-based
providers—to appropriately communicate the importance of facility-based delivery and assist pregnant
FTMs in accessing facilities for delivery.

ANC was another priority health issue

Percentage of FTM program
for the FTP project, including early participants (who have given birth) that
initiation of ANC and the completion of received at least 4 ANC visits
at least 4 ANC visits. Over the course of 68% 66%
the phase 1 program, the project saw an 66%
increase in the percentage of women 64%
62%
that had given birth who had received
60% 59%
at least 4 ANC visits from 59.3% at
58%
baseline to 66% at endline. 56%
54%
A qualitative study conducted by E2A Baseline Endline
that included in-depth interviews and
Figure 1: Percentage of FTM program participants that received at least 4 ANC
focus group discussions with program
visits, phase 1
participants and implementors, also
found that FTMs reported an increased awareness of prenatal care, including the importance of using
services early in pregnancy.

“You carry it, but you don't know anything. You don't know if the child is in the womb, if
it lives or if it is dead, you don't know. So, it's important that you go to the health center
so that the health workers can see the position of the child, because they are the ones
who know how to make sure it's good.” —FTM, 20 years old

The qualitative study also revealed that HTSP/FP knowledge and attitudes also improved for young FTMs
and their husbands.

“If you adopt family planning, you, the mother, will be healthy and your child will be
healthy too. You will be in peace and not in trouble. When I was not yet in the project, I
didn't know all this.” —FTM, 21 years old

“Now people have started to understand. Before, it was not everyone who agreed to talk
about it. But nowadays, people understand that it [FP] is not bad in itself. This is to really
help you take care of your family, to space pregnancies up to the number you want.” —
Husband of FTM, 29 years old

28
Phase 2 Result Highlights
During Phase 2, the project continued to mentor providers that were trained during the initial phase of
the E2A Youth and RISE-FP projects. Throughout the course of the two phases, 175 facility-based
providers were provided with regular mentorship, including on the insertion and removal of implants
and IUDs, improving the quality and availability of FP services in the project areas.

Project monitoring data also showed high participation rates for FTMs, their husbands, and their
mothers-in-law in the community-based small group discussion sessions, indicating that the topics
covered were relevant and of interest and that the project’s efforts to engage key influencers were
successful.

Figure 2: Proportion of enrolled FTMs that participated in group sessions, phase 2

Exposure to the project messages ranges from 94.9% to 72.6%. Session 1 had the highest participation
rate and session 5 had the lowest. This graph shows the participation rates only for villages with an active
FTP program. Therefore, the enrolled FTMs from the 4 villages where the program stopped due to security
situations 15 are removed from the denominator beginning in February 2020. Participation among
husbands and mothers-in-law was similarly high. Over 80% of spouses and MILs participated in two
sessions dedicated to promoting safe pregnancy, assisted childbirth, HTSP and FP among male partners.

The program demonstrated improvements in some key health outcomes of interest during the FTP
lifestage. In regard to early initiation of ANC, of all pregnant women observed up to the end of March

15
Refer to Challenges section

29
2020, 76.47% received their first ANC visit in the first
trimester of pregnancy. This proportion was 62.5% at Proportion of Program Participants
baseline. Furthermore, the proportion of women that Received at least 4 ANC Visits
who have completed at least four ANC visits before
delivery is 69.6%. This rate 68.7% among women
with one child at baseline. During this second phase Less than de 4 ANC 30.4
of the project was also able to add messaging and
indicators related to IPT in pregnancy. While there
are still improvements to be made, during the
intervention period, the percentage of program More than 4 ANC 69.6
participants that received five doses of IPT during
pregnancy increase from 2.5% at baseline to 11.59%
at the end of the intervention. 0 20 40 60 80

As with the Phase 1 of the Youth project, the project Figure 3: Proportion of program participants that received at least 4
ANC visits, phase 2
data shows that almost all program participants gave
birth in a health facility. During the intervention, 69
women gave birth and only two women were not assisted by a skilled attendant (both of whom have birth
in December 2020), representing an assisted delivery rate of 97.10%. At baseline, the proportion of
women who had an assisted delivery was 96.0%, an increase of 1.1 points. It should be noted that the two
unassisted deliveries took place in the villages of Djouma (CSPS of NAYIRI) and Boanga (CSPS of YAMBA)
which are located in areas of high insecurity that have experienced terrorist attacks. In these centers,
health personnel worked only during the day and health services remained closed at night due to
insecurity. Our two young FTMs did not have the chance to benefit from qualified assistance during their
delivery because of the lack of continuity of services due to insecurity. Unfortunately, one of them lost
her baby after he was referred to the CHR de Fada for respiratory distress.

120 BF-430 P5 % Assisted deliveries

100 100 100 100 100 100
80 77.8
60
40
20
0
Octobre 2019 Novembre 2019 Décembre 2019 Janvier 2020 Février 2020 Mars 2020

Figure 4: Percentage of women who gave birth that did so in a health facility, phase 2

The project also saw improvements in early initiation of breastfeeding among program participants. Of all
the births observed during the intervention period, 91.3% of newborns were breastfed within 1 hour of
birth. This indicator improved significantly from baseline, which was 53.3%.

30
 100 91.3

80

60 53.3

40

20

0
Baseline End of Project

Breastfed Within an Hour of Birth

Figure 5: Percentage of newborns that were breastfed within an hour of birth, phase 2

Lastly, contraceptive use increased substantially from baseline (social mapping) to March 2020, rising
from 18.9% to 45.7% during this period. Among the methods adopted, long-acting methods represent
70.3% while they represented 46% in the social mapping. The protection year couple (CYP) for all program
participants monitored was 159.4. During the intervention period, 47 women adopted a contraceptive
method for the first time (new users), 5 for at least a second time (former users), 2 check-ups, and 21
women were received for resupplies. Thus, a total of 75 women accessed FP services during the
intervention period.

Lessons Learned
Through the implementation of the Youth project, E2A and Pathfinder have learned some important
lessons about working with FTPs across the full lifestage to address a range of important health
concerns. For this report, we present three key lessons for future programming with youth and FTPs:

• Use by the Ministry of the groups of young women from the different cohorts that can serve
as a basis for the establishment of health clubs. This program has brought together young, first-
time mothers to learn about important health topics relevant to their current stage of
pregnancy or early parenthood. In order to capitalize on the capacity that was built through the
training of the peer leaders and the educating of the peer group members, the MoH could
consider using the format and members of these groups to establish longer-term health clubs
that would continue to provide essential information and connections to services to these young
women, their families, and their communities. As a reminder, the establishment of health clubs
is envisaged in the national community health strategy adopted by Burkina Faso.

• Inclusion of an "income-generating activities" component in the package of interventions for

young mothers would contribute to their empowerment. Our experiences through the Youth
project, and in learning about the needs and aspirations of FTPs, have highlighted the
importance of addressing their non-health needs during this pivotal time of their lives. For many
FTPs, the transition to parenthood comes with increased responsibility and new demands on

31
 their time, energy, and finances. This can hinder their ability to take health actions and can
impact their overall health and wellbeing. Programs should consider developing project-specific
income-generating activities or finding mechanisms to links FTPs to existing programs or
resources.

• Given the importance of the target, considering this group as a specific group within the
adolescent and youth program would help to better prioritize the needs of FTPs. The
promising results shown through relatively short interventions, as well as the positive
experiences reported by program participants and implementors, indicate that FTP-specific
programming is a worthwhile approach to address the unique needs of this important
population for the benefit of themselves, their families, and the communities in which they live.

Challenges

Terrorist attacks continue to be carried out, with a significant number of internally displaced persons living
in vulnerable situations, particularly women and children, who are the primary victims. The security
situation has impacted project activities since the beginning of phase 1, however, due the worsening
security situation in the East and Center North regions, and based on the recommendations of a security
consultant hired by Pathfinder International Burkina Faso, the project suspended project-implemented
community-based interventions in four of the 20 project villages, including Bongo, Bandaoghin and
Djouma in the health district of Fada and Talle in the health district of Kaya during phase 2. In these four
villages, the sessions with FTMs, husbands, and mothers-in-law as well as the monthly data collection with
FTMs was discontinued from February 2020 onward. This decision was made based on staff’s inability to
travel to these locations as well as the potential risks from the group gatherings to program participants.

The outbreak of COVID-19 infection since March 2020 is also a major challenge in the implementation of
field activities, especially as we enter the last quarter of the project. Due to the suspension of community-
based activities because of the pandemic, 3 out of 10 FTM peer group sessions were not able to be
completed as well as 1 out of 3 husbands’ sessions and 1 out of 2 joint sessions. Furthermore, the exit
questionnaire—which included demographic characteristics; service utilization information; and
knowledge, attitudes, and behavior questions with FTMs and their husbands—was not able to be
completed as planned in April/May 2020.
.
What Worked to Mitigate these Issues
In order to minimize the risks related to insecurity, Pathfinder conducted a security assessment of the
intervention areas and offices housing the project in the 3 regions. This evaluation allowed to make
recommendations such as the abandonment of the use of motorcycles type YBR 125 by the field staff,
the abandonment of some villages, the training of the staff in personal security with the designation of
focal points. While the group sessions and data collection activities were suspended in these villages,
locally-based CHWs were encouraged to continue ensuring that the enrolled FTMs received the MoH-
recommended home visits.

Regarding COVID-19, Pathfinder has adopted a contingency plan which includes the respect of barrier
measures, the wearing of mandatory masks in the workplace, teleworking and a rotation system. The

32
staff has been provided with protective equipment against COVID-19. The small group meetings were
suspended to comply with the instructions taken by the government.

Photo: Delivery of certificates at the end of the personal safety training to the staff

33
ANNEXES

Annex 1: Villages, districts, and intervention areas covered by phase 1 of the project

Region Health Communes Health facility Villages

District

1. CHR de Fada

1. KOARE
2. CSPS Koaré 2. KIKIDENI
3. PENDREDENI

4. NAGRE
5. TAGOU
3. CSPS Nagré GOURMANTCHE
6. HAMDALLAYE
Fada 7. TAMBANGOU

8. NAMOUNGOU
4. CSPS 9. GBERSAGA
Namoungou 10. TANDIAGA

11. KPENCANGOU
Est 5. CSPS 12. MOURDENI
Tanwalbougou 13. TANWALBOUGOU
Fada 14. BALWIDI

6. CM Diabo 15. ZECNABIN

16. YEMTENGA
Diabo 17. NIBODIN/DIABO

7. CSPS Maoda 18. NABISRABOGO

Diapangou 19. BOSONGRI

8. CSPS 20. DIAPANGOU
Diapangou 21. WAKOU

22. TIELBA
23. TILONTI CENTRE
9. CSPS Tilonti
OLIBRAGONI

10. CM Matiacoali 24. TAMKIMBO

34
 25. KANKANTIANA
26. BOALIGOU
27. OUBRINOU

11. CSPS Igori 28. KOGDASSALI

29. DAGOU PEULH
30. BOULMOANGOU
Matiacoali
12. CSPS Ougarou 31. OUGAROU
32. GNIFOAGUIMA
33. PIEGA

34. TIASSERI
13. CSPS de 35. SOAM
Tiassieri 36. KOAMPANDI

Tibga 37. TIANTIAKA

14. CSPS Tibga 38. NASSOBDO
39. TIBGA CENTRE

Yamba 40. NAYOURI

15. CSPS Nayouri 41. TAMBOANGOU
42. KONDOAGOU

43. YAMBA
16. CSPS Yamba 44. TEMBOU
45. DJANKONGOU

46. KANTARI
17. CM Kantchari 47. BANTOINI
48. BOUPIENA

49. BOUDEIRI
18. CSPS Boudieri 50. NABOUAMOU
51. POKITOUGO
Diapaga Kantchari
52. DIANKONLI
19. CSPS Sakoani 53. SAKOANI
54. TIALBONGA

55. MANTOUGOU
20. CSPS Sampieri 56. PIEMPIENGOU
57. SEMPIERI

35
Annex 1: Villages, districts, and intervention areas covered by phase 2 of the project

Region Health Communes Health facility Villages

District

1. Comboari
1.Diapangou

DIAPANGOU
2. Bolombili
2.Tilonti

3. Bandaoguin
3.Koaré
FADA

TIBGA 4. Bilingtenga
4. Tibga

FADA
5. Boanga
5.Yamba
EST YAMBA
6. Djouma
6.Nayouri

DIABO 7. Boulyoguin
7.CM/ Diabo

8. Maoda Centre
8.Maoda

BOGANDÉ BILANGA 9.CSPS Bilanga 9. Sékouantou

10.CSPS Bilanga- 10. Bilanga-Yanga

Yanga

11.CSPS Kierghin 11. Kierghin

36
 12.CSPS 12. Kossougoudou
Kossougoudou

MANNI MANNI 13.CSPS Manni 13. Bantampèra

THION 14.CSPS Diaka 14. Siéssin

15.CSPS du 15. Silmiougou

KAYA secteur 6

16.Tangasgo 16. Tangasgo Centre

KAYA
17.CM de Pissila 17. Pissila Centre
CENTRE
NORD PISSILA
18.CSPS de 18. Talle
Lilboure

19.Toyogdin 19. Toyogdin Centre

TOUGOURI TOUGOURI
20.Taffogo 20. Yangrin

37