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‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara
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‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara

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How do you promote the health and well-being of adolescent girls? This presentation provides critical insights and strategic considerations based on conversations with people in Mtwara, Tanzania.

How do you promote the health and well-being of adolescent girls? This presentation provides critical insights and strategic considerations based on conversations with people in Mtwara, Tanzania.

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  • 1. ‘Falling Through the Cracks’ Adolescent Girls in Tanzania Insights from Mtwara Maggie Bangser Independent Consultant On behalf of Juárez and Associates, Inc. March, 2010
  • 2. Scope of Work Consultancy for USAID/Tanzania • Compile available information • Study the extent of the problem • Assess the underlying causes • Assess opinions on causes and solutions • Identify relevant initiatives in place • Recommend strategies 2
  • 3. Methodology • Document review – ~65 reports, studies, policies, guidelines, project materials • Two week field visit to Mtwara – Mtwara town, Peri-urban Mtwara, Mtwara Rural • Interviews with ~150 people – 73 students, parents, teachers, school officials – 26 day-laborers/Vibarua/Mama Ntilie – 26 NGO/INGO, activists, researchers, media – 8 health workers – 7 government officials – 5 donors – 5 business people and ‘others’ 3
  • 4. Caveats • Number of people interviewed; sites visited • Types and number of documents reviewed • Language • Timeframe (35 days total) • Not an independent evaluation • Not exhaustive 4
  • 5. Key themes 1. Economic and social marginalization of Mtwara 2. Families in flux and on the move 3. Sexuality is alive 4. Education and health - achieving minimal change 5. “Patchy patchy projects” 6. “I want to be a doctor” 5
  • 6. 1. Economic and social marginalization of Mtwara 6
  • 7. 7
  • 8. % of 15-19 year old females unable to read a sentence Region 15-19 20-24 Rukwa 65.9 45.5 Tabora 58.7 53.5 Mtwara 36.0 47.0 Kagera 25.1 39.0 Dar es Salaam 10.1 17.2 Zanzibar South 9.5 14.4 Source: PopCouncil/2004-5 DHS 8 8
  • 9. “These people have nothing. Nothing.” 9
  • 10. 2. Families in flux and on the move 10
  • 11. . Three quarters of the children I met were living with one or neither parent. 11
  • 12. “Even if you want ten girls now, you’ll get them” 12
  • 13. 3. Sexuality is alive 13
  • 14. “ ‘Sexual health’ is having enough sex and being sexually satisfied.” 14
  • 15. Unyago’s place Gender roles and Economic reality social expectations Unyago 15
  • 16. “Rituals contribute to sexuality in as much as they are the ‘teaching tool’ within a larger model of sexuality and gender roles”. 16
  • 17. 4. Education & health - achieving minimal change 17
  • 18. Only half the teachers present 18
  • 19. “How are you?” “YES!” 19
  • 20. Collective punishment “They don’t know how to read”, said the teacher. 20
  • 21. Toilets are a serious problem. What happens to girls who are menstruating? 21
  • 22. “We already gave her a chance” 22
  • 23. Still no national sexual health curriculum 23
  • 24. Official fees Tsh 20-40,000/yr Actual Tsh 250,000/- 24
  • 25. 25
  • 26. “The poor don’t get health services” 26
  • 27. Health care in Mtwara “No health worker wants to come down here” Fees a major barrier to care Nangaruwe Health Centre 200-300 people/day 10 staff including 2 Clinical Officers No AMOs 7 hour wait to see ‘doctor’. Community Health Fund Tsh5,000 per year for family of 8 Many can’t afford, some don’t understand it. Only government workers can afford health insurance. 27
  • 28. Virtually no ‘adolescent friendly health services’ 28
  • 29. SRH for adolescents • No budget line in the MTEF for adolescent health in the past two years • No AFHS in Mtwara, or largely anywhere • Good guidelines and standards, but no implementation 29
  • 30. 5. ‘Patchy patchy’ projects 30
  • 31. Who’s working in Mtwara? • PASHA • EngenderHealth • Stadi za Maisha • Clinton Foundation • MAISHA • ActionAid • EGPAF • AMREF • Ujana/ISHI • CHAI • Marie Stopes • Basic Needs • Fataki • BMAF • UNICEF • DHIP • TGSPH • JICA • INSIST • NEDA • MEDA • CSSC • Reproductive Resilience study • HKI • Sexual coercion study • TASAF (upcoming) • TMARC/Families Matter • UMATI • …………… • WAMA 31
  • 32. Or we just need more guidelines and materials? 32
  • 33. 6. “I want to be a doctor” 33
  • 34. Moving Forward Some options 34
  • 35. What, precisely, IS the motivation to stay in school? 35
  • 36. Or not to get pregnant? 36
  • 37. Option 1: Targeted interventions 1. Support a life-skills program for youth that fundamentally addresses vulnerability Expand reach of in-school extracurricular materials Develop, implement, evaluate an out-of-school PASHA 2. Cautiously test ‘influencing’ unyago 3. Assess and scale up pilot interventions reaching marginalized girls, often linking SRH with financial literacy and skills Safe spaces (e.g., Binti Pamoja/Kenya; Biruh Tesfa/Ethiopia) Married girls clubs (e.g., Berhane Hewan/Ethiopia) Out of school girls’ needs (e.g., Ishraq/Egypt) Girls’ empowerment (e.g., Girls Power Initiative/Nigeria ) (Source: Population Council) 37
  • 38. Option 1: Advantages and Risks Advantages? • More focused, specific, possibly more measure-able • More akin to standard ways of operating Disadvantages? • Reach a limited number of girls • Likely be more “patchy patchy” projects • Unlikely to yield broad, sustained and deep impact 38
  • 39. Option 1b: broadened sector-wide programming 1. Family planning including particularly for youth A renewed commitment to accessible, affordable and quality family planning services is urgently needed in Tanzania 2. Post abortion care (PAC) PAC services could be scaled up across Tanzania to save lives, with potentially significant gains for women and girls’ wellbeing 3. Adolescent Friendly Health Services (AFHS) Secured and sustained funding is needed for AFHS, through the MTEF for direct implementation of AFHS; training, supervision and monitoring
  • 40. Option 2: Sustained and systemic Seven strategic approaches to strengthen rights, equity and accountability for adolescent girls 40
  • 41. 1. Deploy teachers and health workers equitably
  • 42. Harmful pattern of deployment General Budget Support note, 2008 • HR distribution remains highly uneven and the gap has widened • Many needier and poorer Tanzanians are underserved compared to better off “Lower allocations to poor local authorities correlate with worse pupil teacher ratios, enrolment rates, and exam pass rates even while controlling for the direct effects of poverty on performance.” • Main underlying causes Attracting/retaining workers to under-served areas Continued recruitment and transfers to better served districts • Measures needed to change patterns Incentives Limit transfers…
  • 43. 2. Agree and rigorously enforce measures of accountability
  • 44. Measuring change • Target outcomes, not inputs or outputs • Require an independent, evaluation by an entity that has nothing to gain • Examine policy and service delivery change Are pregnant school girls being re-admitted? Are life-saving services e.g. family planning and post- abortion care being expanded significantly, and accessed by the poorest women? • Determine who is not being reached • Dis-aggregate data on adolescents 44
  • 45. 3. Get resources to the school and facility level 45
  • 46. Make money work locally • Capitation grant not reaching schools at agreed levels • Increases pressure to fill the gap Schools struggling to make up the difference Families forced to fund what government is supposed to provide Coercion reported • What about a ‘capitation grant’ for health facilities?
  • 47. 4. Invest in water and sanitation 47
  • 48. Decent environments • Few, if any, water points and toilets at schools despite PEDP funding Rarely at health facilities too • Most money going to classrooms and teachers’ housing (and even that is often shoddy) • Ensure government plans and allocations for water and sanitation are explicit, and monitored
  • 49. 5. Institute positive incentives for performance 49
  • 50. Reward what (and who) works • ‘Cash on Delivery’ or ‘Pay for Performance’ Quick example… $50/child who passes Div III $100/child who passes Div II 3/4 the funds to the school; 1/4 the funds to the teachers • President Kikwete has reportedly endorsed • Center for Global Development (Washington) ready to assist • No doubt, there are huge challenges, but taking the risk could have big pay-offs
  • 51. 6. Pilot an information and transparency ‘platform’ in Mtwara 51 'Falling Through the Cracks' 51
  • 52. Information access • Publicly available, widely disseminated information (print, radio, on-line) • Data on budgets, allocations, performance results, infrastructure, etc. • Stories, photos, innovations • Strong link to local/national media • Private company manage
  • 53. 7. Explore savings, microfinance 'Falling Through the transfers and cash Cracks' 53 53
  • 54. The link to livelihoods Economic vulnerability drives behavior, including high-risk sex, so get to the root of the problem • Savings programs for adolescent girls – Bring together life-skills and financial opportunity • Cash transfers for poor families (e.g., Progresa/Mexico) • Micro-credit

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