This project aims to improve the Maternal and Child Health (MCH) and Reproductive Health (RH) *1 situations of rural areas in the northern part of Syria by making health and medical services accessible to community people.
JICA conducted the three-year project named "Strengthening Reproductive Health in Syria (Phase 1)" from June 2006 to Mar 2009 in the Manbej district of Aleppo governorate in Syria. Phase 1 employed methods aimed to "improve the quality of MCH and RH services at Health Centers (HCs)" and to "encourage community people's behavioral change" in parallel. The terminal evaluation conducted at the end of the project period in November 2008 confirmed the enhancement of the managerial capability of Health Centers, and the increase in the use of RH services by community people.
Later, upon request by the Syrian government, JICA decided to conduct Phase 2 of the project in order to further improve the approaches taken in Phase 1 and to extend its benefit further into other rural areas.
Project Phase 2 which began in January 2010 is underway for three years. The approaches (Output 1 and Output 2) taken in Phase 1 will be improved to be more effective during Phase 2. In addition, another important purpose was added, which is capacity building in planning and managing health administration of the Governorate and Health District Offices (Ouput 3) (see Figure 1).
Figure 1 Project Design
*1 Reproductive Health
Reproductive health means "sexual health and reproductive health of both males and females throughout their life." It covers various elements such as maternal and child health, family planning, adolescent health, HIV/AIDS and sexually transmitted diseases (STDs) and infertility. This project primarily focuses on maternal and child health, and family planning among them.
The project target areas are four districts, namely, Manbej, Al Bab and Deir Hafer districts in Aleppo, and Khan Shikhun district in Idlib (Figure2). The beneficiaries are about 50 health administrative officers at the governorate and district offices, about 415 staff members at Health Centers (including 2 other primary care institutions) and around 960,000 men and women in the reproductive age group between 15 and 45 and their families in the target areas.
Figure 2 Map of Target Areas
This project will take the two approaches described below. It is expected that by working together with counterpart organizations and community people, the effects will be integrated and synergized, leading community people to adjust their behavior (behavior change communication=BCC) to improve their reproductive health (Figure 3).
In order to enhance the quality and expand the delivery of reproductive health services at HCs, the project seeks:
The project encourages people to change their behavior by communicating RH messages (BCC) in various ways. It involves community organizations, religious leaders and community leaders in three types of health education activities. They include 1) mass education at health centers, 2) group sessions through out-reach activities (mobile teams) and 3) individual guidance through home visits by midwives and community health volunteers (CHVs). The project will also cooperate with private clinics, which are estimated that 98 percent of expectant mothers are using (KAP survey 2010), to deliver RH messages.
Figure 3 Two Approaches
Capacity enhancement of health administrators at the governorate and district levels is emphasized as well, in order to ensure that these approaches will be sustained even after the completion of the project. As a first step, the project is encouraging the District Health Offices to formulate their annual work plans, as they have never planned or implemented their health administration on their own initiative. Based on the plans, the project encourages them to establish a training system, to organize a supervising system, and to organize and promote a community health education system for their respective districts.
The 5S stands for Sort, Set, Shine, Standardize and Sustain. The concept was developed from manufacturing processes and has been used by the manufacturing industry to improve their working situations. At health and medical scenes, the 5S concept is applied to the orderly organization of medicines and patient files, and to the preparation of better working environments for clinical staff.
The project makes reference to Japan’s postwar activities such as community health service systems: model villages where planned births were promoted by the Public Hygiene Institute (in those days) which was promoted planned parenthood, activities by public and private midwives and public health nurses as leaders, and the “New Life Movement” by the private sector.
The project is carrying out sustainable comprehensive community activities obtaining cooperation from the Syrian Family Planning Association (with its long experience in spreading family planning), Women's Federation, Teachers' Union, the political parties (having control over communities and their supporter groups), and religious leaders.
Currently one public health nurse is working in Manbej district as a volunteer (JOCV). In the future, JOCVs in the health field will be sent to Al Bab and Khan Shikhun districts. The project exchanges information, and works in cooperation when necessary with these JOCVs who work in assigned communities.
As shown in Figure 4, the Project Steering Committee is placed on top, under which the Project Technical Committees at the governorate level, and the District Working Teams at the district level are established. Information sharing and cooperation will be intensified not only vertically but also horizontally among these organizations.
Figure 4 Implementation Structure