HFHC-Executive-Summary EN by Oxfam Canada

her future her choice EXECUTIVE SUMMARY

STRENGTHENING THE SRHR OF ADOLESCENT GIRLS AND YOUNG WOMEN

Her Future, Her Choice

Strengthening Young Women’s Sexual and Reproductive Health and Rights

Executive Summary - HFHC Final Endline Evaluation Report

Evaluation Team: Jennifer Sawyer, Ophelia Chatterjee, and Lara Jean Cousins

Client: Oxfam Canada

December 2024

Acknowledgements & Disclaimer

This report was prepared for Oxfam Canada by Jennifer Sawyer, Ophelia Chatterjee, and Lara Jean Cousins between May and December 2024. The authors would like to thank all of the Oxfam Canada staff, Oxfam Country Office teams, HFHC partners, and community stakeholders who participated in this evaluation and support this process. The authors acknowledge and appreciate the work of the Country Evaluation teams who collected data on the ground which informed this evaluation. Heartfelt thanks to Jose Chacon, Oxfam Canada’s MEAL Officer for SRHR, who helped steer and guide this process.

For more information and questions about this study, please contact: Jose Chacon, MEAL Officer jose.chacon@oxfam.org

Oxfam Canada

Oxfam Disclaimer

This study was commissioned by Oxfam for the Her Future Her Choice (HFHC) project, funded by Global Affairs Canada. The findings, interpretations, and conclusions expressed in this work do not reflect those of Oxfam or Global Affairs Canada. Please also note that the statistics in this report are not comparable to national level statistics; the study was carried out in sample groups in targeted project areas and the statistics are therefore not reflective of standardized national data. While every attempt has been made to ensure data quality, Oxfam acknowledges that there may be some limitations in the information shared in this report. Data gaps may occur in relation to national programs that might affect the accuracy of the data included in this work.

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Acronyms and Abbreviations

ABYM Adolescent Boys and Young Men

AB Adolescent Boys

AGYW Adolescent Girls and Young Women

AG Adolescent Girls

CAC Comprehensive Abortion Care

CAD Canadian Dollars

CAG Community Action Group

CAT4SRHR Capacity Assessment Tool for Sexual and Reproductive Health and Rights

CBO Community Based Organization

CEFM Child, early and forced marriage

COPUA Coalition for the Prevention of Unsafe Abortion

CSA Comparative Statistical Analysis

CSE Comprehensive Sexuality Education

CSO Civil Society Organization

DHS Demographic Health Survey

ETB Ethiopian Birr

FGD Focus Group Discussion

FP Family Planning

GAC Global Affairs Canada

GBV Gender-Based Violence

HFHC Her Future, Her Choice

HIV Human Immunodeficiency Virus

HMIS Health Management Information System

IDP Internally Displaced Person(s)

IEC Information, Education and Communication

IUD Intrauterine Device

KII Key Informant Interview

MEAL Monitoring, evaluation, accountability and learning

MTE Midterm Evaluation

MVA Manual Vacuum Aspiration

NGO Non-Government Organization

OCA Oxfam Canada

OM Older Men

OR Odds Ratio

OW Older Women

PAC Post-abortion Care

PMF Performance Measurement Framework

SHG Self-Help Group

SRH Sexual and Reproductive Health

SRHR Sexual and Reproductive Health and Rights

STI Sexually Transmitted Infection

VCAT Values Clarification and Attitude Transformation

VSLA Village Savings and Loans Association

WRO Women’s Rights Organization

YCBDA Youth community-based distribution agents

YFHS Youth Friendly Health Services

YLO Youth-Led Organization

YM Young Men

YW Young Women

EXECUTIVE SUMMARY

The Her Future, Her Choice: Strengthening Young Women’s Sexual and Reproductive Health and Rights (HFHC) (2019-2024) project was funded by Global Affairs Canada (GAC) and Oxfam Canada (OCA). With an ultimate outcome of improved sexual and reproductive health and rights (SRHR) for adolescent girls and young women (AGYW) in targeted districts of Ethiopia, Malawi, Mozambique, and Zambia, the project sought to directly address barriers that hinder AGYW’s SRHR in project communities. HFHC used a comprehensive approach aimed at promoting and defending the SRHR of AGYW, with the aim of creating long-lasting transformative change. The project was framed around three strategic pillars:

• Pillar 1 promoted positive gender- and sexuality-related norms around SRHR, while cultivating the uptake or “demand” for SRHR information and services at individual, household, and community levels;

• Pillar 2 addressed the “supply” of comprehensive SRHR information and high-quality services delivered by health care facilities and health service providers;

• Pillar 3 cultivated an enabling environment by supporting Women’s Rights Organizations (WROs) and Youth Led Organizations (YLOs) in undertaking action, advancing rights related to SRHR, and influencing related policies.

The HFHC project focused on AGYW aged 10-24, as they experience the most adverse impacts on their health and rights as a result of harmful socio-cultural norms and practices; poor SRH service provision; and experiences of child, early, and forced marriage (CEFM), adolescent pregnancy, unsafe abortions and violence. Over the course of the project, HFHC reached over 353,111 individuals, primarily women and girls (79%), in 10 districts across Ethiopia, Malawi, Mozambique, and Zambia; 47% more than the initial target of 240,000.

Evaluation Purpose and Scope

The objective of the endline evaluation was to assess the impacts generated by HFHC project interventions in Ethiopia, Malawi, Mozambique, and Zambia, as well as to inform and improve practices in SRHR future programming. In doing so, the final evaluation was intended to:

• Assess the project’s overall progress on achieving outcomes against the Theory of Change, Logic Model and baseline values given in the Performance Measurement Framework (PMF);

• Provide a deep understanding of the differentiated impacts in each country;

• Identify project learnings and key implementation strategies for each project pillar;

• Assess the sustainability of achieved results and impacts; and,

• Present recommendations for future SRHR projects.

Structure of the Report

The Final Evaluation report is structured as follows: Firstly, the methodology provides insight into the data collection methods, feminist MEAL principles and ethical considerations, as well as limitations. Subsequently, a brief overview is given of cross-cutting contextual and programmatic factors and challenges that affected project implementation across the four countries, before the consolidated findings are outlined. This is followed by an analysis of differentiated country-level findings and approaches. The next sections outline conclusions, key lessons learned, and provide key recommendations for future SRHR programming. Supporting documentation is provided in annexes.

Additionally, four pieces of research were produced that provide additional information that might be relevant to the reader: The Meta Analysis provides a quick overview of key project information such as all annual reports submitted to the donor and impact stories collected during the life of the project. Three knowledge products provide a deep dive into Safe Abortion, Saving Groups, and the Drivers of Change

Methodology Overview

The final evaluation study and data collection methodology were designed by Oxfam Canada and Oxfam country offices. Primary data collection (endline survey, Focus Group Discussions, and Key Informant Interviews) was conducted by national consultancy teams in each country, under the supervision of the Oxfam country offices. In-country quantitative and qualitative data collection comprising a household survey, and KIIs and FGDs, respectively, took place with AGYW aged 10-24, women and men aged 25-50, project partners, and external stakeholders (e.g. teachers, peer educators, health workers, village secretaries, and district and health facility focal points), between May and September 2024. To supplement in-country data collection, the international consultancy team conducted a qualitative desk review of key HFHC documents and held KIIs with project partners and the OCA SRHR Manager. The international consultancy team then conducted the analysis, synthesis and summation of data collected, the insights of which are captured in this evaluation report.

In the course of the evaluation, the international consultancy team prepared four Comparative Statistical Analysis (CSA) reports, using the quantitative survey data to analyze change from over time (from baseline to endline) in a range of key program indicators (mainly outcome and impact) in each country. The team also prepared a Meta-Analysis report to summarize findings and insights from the desk review and endline qualitative data (where available); a summary report to capture the key insights and reflections from the KIIs; and three individual knowledge products honing in on key learnings and strategies from the HFHC project.

Ethical considerations were applied throughout the study design and implementation. The international consultancy team strove to apply a transformative gender lens informed by feminist MEAL principles throughout the evaluation process as well as in the analysis of findings and lessons learned. However certain factors beyond the team’s control limited their ability to influence and control the application of these principles. Other limitations included:

• A lack of comprehensive historical documentation or record of changes that were made to the HFHC project’s overall evaluation design and measurement plan over the course of the project.

• The international consultancy team were hired to conduct a summative evaluation, and were not involved in the design of the evaluation and data collection tools, or in the execution of the

in-country data collection. While this was intended to help streamline processes and reduce the burden of coordination that fell upon the international team, it also meant that the team had no control over the quality, process, or timeline.

• Certain delays to the timeline occurred during the course of the evaluation that affected the team’s ability to execute the evaluation as planned during the inception phase, the extent to which evaluation deliverables could build off each other, as well as the evaluation team’s ability to systematically triangulate findings.

• Challenges with the quality and availability of both the quantitative and qualitative data, which limit the rigour of this evaluation and the reliability of findings.

- Quantitative: Changes were made to the survey tool between baseline and endline which limit the comparability of data. Furthermore, the small sample sizes of AGYW for some indicators, particularly those related to sexually active or partnered adolescents, made it difficult to generalize findings. Meanwhile, challenges with enumeration and translation at baseline and/ or endline impact the reliability of results. Finally, specific challenges were experienced in Ethiopia, where the ongoing conflict in the region impacted the composition of communities and the endline data collection process, potentially influencing the assessment of project outcomes.

- Qualitative: Qualitative endline data from all implementation countries was either unavailable, limited or of substandard quality. As a result, the majority of the qualitative data included in this study was anecdotal in nature, drawing on partners’ annual reporting at project outcome level, making it challenging to draw robust conclusions and identify trends across contexts. The reliance on annual reporting also created an imbalance in the data available from the countries of implementation, and across the different pillars. There was a much greater emphasis in annual reporting on Pillar 1 than Pillars 2 and 3, with Pillar 3 facing the biggest shortfall.

Given these challenges and limitations with both qualitative and quantitative data, findings of this evaluation should be interpreted with caution.

Highlights from Evaluation Findings

Over the course of the implementation period (2019-2024), Ethiopia, Malawi, Mozambique and Zambia all navigated a period of significant challenges and upheaval as a result of intertwined political, economic, environmental and health-related factors that impacted project implementation and critically shaped the lives of AGYW and their families. Contextual challenges included the COVID-19 pandemic; conflict and political turbulence; economic challenges related to inflation and currency devaluation; environmental crises, including severe drought, cyclones, and flooding; and cholera outbreaks. A number of cross-cutting programmatic challenges (distinct from the context-related challenges) also affected implementation in most, if not all, contexts, including but not limited to cultural, social and policy barriers; SRH commodity stock-outs at health facilities; and retention of trained staff at health facilities.

ULTIMATE OUTCOME: IMPROVED SRHR FOR AGYW (1000)

Between baseline and endline, the overall adolescent pregnancy rate fell from 23% to 14%, indicating progress toward the project’s ultimate outcome. This exceeds the project’s endline target, although results vary by country. The quantitative data suggests that the reduction is almost entirely due to the decline in pregnancy rates among sexually active unmarried girls as well as the reduction in early marriage, as among ever-married girls the reduction was much smaller and statistically nonsignificant. The quantitative data also suggested large increases in the percentage of sexually active adolescents and young people (both male and female) who reported currently or ever using contraception

There was also an overall positive shift in attitudes towards women’s SRHR across all countries, with moderate increases of between 3-10% observed in most age and gender groups . While these changes indicate a general improvement, not all shifts were statistically significant, with variations across countries. Mixed trends underscore the need for continued focus on strengthening SRHR attitudes, and/or exploring different strategies, especially among demographic groups or in countries where support has not uniformly increased.

PILLAR 1: STRENGTHENING THE AGENCY OF AGYW IN EXERCISING THEIR SRHR

Overall across all countries there was an increase in the percentage of sexually active or contraceptive-using AGYW who independently or jointly made the decision to use contraception; from 13% to 38% among adolescent girls, and from 18% to 60% for young women (1100.a). The meta-analysis points to wide-ranging, knock-on impacts in terms of AGYW’s confidence, agency and decision-making, from making informed decisions on contraceptive use; having a safe abortion to end an unwanted pregnancy; returning to school to continue education; or using their knowledge to inform other AGYW about their SRHR.

HFHC paid particular attention to changing norms and attitudes of a wide range of community stakeholders, in addition to working directly with AGYW. The qualitative data suggests that the shift in attitudes of key community gatekeepers - including parents, teachers, health workers, and community, traditional and religious leaders - has been a key success of the project.

HFHC also worked on AGYW’s economic empowerment, recognizing its potential synergies with SRHR, and that economic independence can increase AGYW’s autonomy and decision-making power. Smallscale economic empowerment interventions in the form of self-help and savings and loan groups provided an entry point for SRHR programming, serving as a platform for SRHR and GBV discussions, education, and service provision. The qualitative results in this regard are promising, suggesting that working with self-help groups and Village Savings and Loans Associations has helped increase participating AGYW’s economic independence, improve household relationships, and increase AGYW’s SRHR awareness, confidence and leadership.

PILLAR 2: IMPROVING THE QUALITY OF COMPREHENSIVE SRH INFORMATION AND SERVICES FOR AGYW

HFHC aimed to improve access to a comprehensive range of quality SRH services by training health service providers on SRH and youth-friendly services, while also working to address supply chain, budget, and policy challenges at health facilities. The qualitative data indicates that significant progress was made towards strengthening the knowledge and capacity of health service providers and participating facilities. The project trained 3,949 health service providers, exceeding its target, and thereby helped improve access to vital services such as contraception, safe abortion, and youth-friendly health care. This training also served to transform the attitudes and behaviours of

health service providers, enabling them to create more welcoming environments for young people, particularly AGYW, seeking SRH services. This success is reflected in the large numbers of AGYW who were referred to and/or received SRH or GBV services through the project.

Of note is the progress achieved in increasing access to safe abortion and post-abortion care, which was a particular focus of HFHC partners in all four countries. Project reporting shows a year on year increase in safe abortion and post-abortion care at participating health facilities, with a final cumulative total of 10,327 safe abortion and post-abortion care services provided, underscoring the impact of HFHC’s support in expanding access to these essential services.

However this did not necessarily translate uniformly into increased (perceived) access to SRH services in specific countries in the endline evaluation’s quantitative data. Overall, adolescent girls saw a slight decrease in perceived access from 30% to 27%, while young women reported an increase from 43% to 54%. Endline targets were not met for either group, and were missed by a larger margin for adolescent girls, however findings should be treated with caution as the endline results are based predominantly on small sample sizes. It should also be noted that results varied significantly per country, and an increase was in fact seen in Malawi for both age groups. According to the survey data, in every country the percentage of adolescent girls and young women who reported that they could afford a family planning method if they wanted to obtain one was lower (often by a very large amount) than the percentage who stated that they could easily reach a place providing such products. This indicates that across all countries, (perceived) lack of affordability was the main issue that contributed to stagnated or slow increase in this indicator

On balance it appears that HFHC has contributed to strengthened SRH service provision at participating facilities, although questions remain about AGYW’s uptake of these services. Challenges also remain in relation to SRH commodity stock outs, staff rotation and supply chain management, all of which affect service consistency.

PILLAR 3: IMPROVING THE EFFECTIVENESS OF WROS AND YLOS TO ADVOCATE FOR SRHR

Based on OCA’s Capacity Assessment Tool for Sexual and Reproductive Health and Rights (CAT4SRHR), six of the 10 partners engaged in HFHC at the end of the project recorded an increase in their capacity score, exceeding the target of five partners. The remaining four partners did not complete the endline assessment, so no score was available for them. While the CAT4SRHR trajectory faced numerous challenges, overall the process was seen by partners and OCA as an effective tool for organizational capacity strengthening, contributing to a better understanding of SRHR objectives and enhancing overall program effectiveness.

Beyond supporting the capacity of project partners, the meta-analysis indicates that HFHC contributed to capacity strengthening of local Women’s Rights Organizations (WROs) and YouthLed Organizations (YLOs), as well as legal and policy advocacy in challenging contexts. At the local level, HFHC worked in partnership with local leaders, for example in Malawi and Zambia where new and updated bylaws help protect AGYW from CEFM, harmful aspects of initiation ceremonies, early and unwanted pregnancy, school dropout, and sexual violence. At the national level, HFHC partners have participated in - and connected WROs and YLOs to - various advocacy platforms and coalitions working on a range of issues related to the advancement of AGYW’s SRHR.

In terms of promoting change in SRHR policy frameworks, HFHC partners worked towards different advocacy objectives relevant to each country’s context and priorities, while building connections with existing alliances, and strengthening participation of WROs and YLOs in advocacy-related spaces at local and/or national levels. For example, in Malawi, HFHC worked closely with WROs, YLOs and

other CSOs to push for an increased allocation for SRHR in the national budget, resulting in a 13% increase in the budget allocation of SRH commodities in the 2023-2024 budget, and an increase in the national health budget from 8.5% to 12.2% for 2024/2025. Easing the country’s legislative restrictions regarding abortion through the adoption of the Termination of Pregnancy Bill has also been a core advocacy focus, although legislative reform has been slow due to strong opposition from religious and cultural groups, lack of political will, and the perpetuation of misconceptions and misinformation surrounding abortion. While the Bill is yet to be passed, HFHC safe abortion advocacy efforts, campaigns, and community engagement have laid a strong foundation for future successes in promoting safe abortion and improving SRH outcomes in Malawi. In Zambia, when in 2023 the government issued a directive prohibiting any mention of sexual rights, HFHC partners and other civil society actors collaborated to push back on this directive, working together to illustrate to the government how this policy would negatively affect SRH information sharing and other SRHR interventions. Thanks to these efforts, the directive was reversed. Additionally, partners participated in the development of the consultative meetings of the 8th National Development Plan (2022-2026), and a review of the Adolescent Health Strategy, securing greater responsiveness to the health needs of adolescents, as well as issues such as education, poverty, and inequality, thus improving the policy environment for youth SRHR in Zambia.

Conclusions, Lessons, and Recommendations

HFHC sought to improve the SRHR of AGYW in targeted districts of Ethiopia, Malawi, Mozambique, and Zambia, taking a comprehensive, holistic, multifaceted approach to address the barriers AGYW experience which prevent them from exercising their SRHR. HFHC applied a number of strategies to address these barriers, working to improve young people’s SRHR knowledge and access to SRH services; shift attitudes and strengthen skills of critical gatekeepers - including parents, health service providers, community, traditional and religious leaders - to help them to exercise those rights; and either influence or lay the foundation for important legal and policy changes. These strategies can clearly be seen as corresponding directly to the needs of the core target group - AGYW. Despite various contextual and programmatic challenges, along with limitations that make it important to exercise caution when interpreting this evaluation’s findings, the international consultancy team believes that HFHC has made a significant contribution towards advancing AGYW’s SRHR.

Understandably, further work is required to fully overcome cultural and systemic barriers. In this regard, it is also important to note that HFHC identified and prioritized districts with some of the poorest or even worsening SRHR trends, entailing that from the outset of the project, Oxfam and partners had their work cut out for them. While achieving AGYW’s health, rights, and wellbeing is a long term process and requires long horizons in order to bring about lasting and transformative change, HFHC has made promising headway to this effect. A number of lessons learned and recommendations have surfaced over the course of project implementation and this evaluation, which are captured below.

LESSONS LEARNED

SRHR PROGRAMMING

• A holistic understanding of and approach to SRHR can enable partners to address diverse needs in different contexts.

• Strong partner collaboration and a comprehensive, collaborative approach can strengthen results to advance AGYW’s SRHR.

• Improving AGYW’s economic conditions can be an important strategy to enhance AGYW’s agency and health-related decision making.

• Tailoring project messaging and rationale to community and traditional leaders, and other influential community stakeholders creates greater buy-in and credibility in communities, and gives momentum to project messaging.

• Working with existing structures helps amplify existing efforts, builds community ownership and enhances sustainability.

• Sustained and synergistic awareness-raising, advocacy, capacity building and partnership are needed to ensure access to SRH services, particularly safe abortion services.

• Values clarification and attitude transformation (VCAT) interventions are powerful tools for changing attitudes regarding safe abortion.

• Rights-based messaging is a priority area for strengthening SRHR initiatives.

• Working in the public health system presents specific challenges that need to be accounted for in program design and implementation.

• Strengthening supply chains and stock management requires increased focus and targeted strategies.

• Where budgets allow, CAT4SRHR would benefit from more resourcing (human and financial) to enhance commitment and results.

• Achieving shifts in SRHR legislative and/or policy frameworks takes time, and requires strategies for addressing resistance and pushback.

PROJECT MANAGEMENT AND FEMINIST MEAL

• Shared understanding could be improved through strengthened overall knowledge management, including a clear record of decisions taken over the course of the project.

• An adaptive approach to programming allows partners space to respond to changes in their context.

• Stronger or more suitable evaluation methods may more meaningfully capture project impact.

• For SRHR programs to live up to feminist MEAL principles, they need to adequately prioritize time, processes, capacity support, and resources.

RECOMMENDATIONS

OXFAM AND OTHER INGOS

• Adopt an adaptive approach in all future (SRHR) programs.

• Continue the use of holistic approaches which work to address multiple barriers to AGYW’s SRHR.

• Integrate (more) targeted interventions to reduce CEFM and meet the SRHR needs of married AGYW.

• Continue to use VCAT methodologies, not only for abortion but for other areas of SRHR, such as adolescent sexuality, sex positivity, SOGI and LGBTQI+ rights, with partners and Oxfam staff.

• Use evaluation design more strongly informed by (participatory) qualitative and/or mixed methods to better capture changes in agency, norms, and attitudes.

• Ensure country teams, partners, and consultants/enumerators have capacity to conduct evaluations and data collection.

• For quantitative data, develop shorter, more targeted surveys to administer with statistically significant sample sizes, while honing in on relevant questions for specific target groups.

• Ensure alignment between outcomes and indicators to accurately measure the intended change.

IMPLEMENTING PARTNERS

• Continue efforts to combat misconceptions and foster supportive environments in order to sustain progress made in AGYW’s SRHR decision-making.

• Where possible, integrate SRHR and economic empowerment initiatives within gender transformative programming.

• Build in a Training of Trainers approach to training health service providers to mitigate challenges of staff rotation.

• Redouble efforts to improve supply chain management and logistics.

• Continue advocacy efforts to improve the policy environment for AGYW’s SRHR.

• Develop strategies to engage with moderate conservative groups or individuals who oppose national level SRHR reforms.

GAC AND OTHER SRHR/FEMINIST DONORS

• Ensure that grantmaking policies, procedures, reporting, and evaluation requirements are compatible with a feminist lens.

• Ensure that multi-country projects have sufficient administrative resources, in order for project implementers to be able to fully provide necessary and timely support to partners and project stakeholders.

Country-Specific Recommendations

ETHIOPIA

• Strengthen the participatory nature of the evaluation process, through engaging partners from the beginning in the design of evaluation tools.

• Improve evaluation management processes through working with international consultants who lead the whole evaluation process, including the hiring of local consultants and working directly with them.

• Develop not only nexus but “triple nexus” gender transformative programming, accounting not only for the intersections and synergies between SRHR and livelihoods/economic empowerment, but also the realities of working in conflict-prone areas or climate-affected areas.

• Where available, use HMISS data to triangulate evaluation quantitative and qualitative data.

• Strengthen the capturing and enumeration of qualitative data, in order to increase the potential for attribution.

MALAWI

• Include clear strategies for the engagement of male SRHR advocates in future programming, as they were significant champions in awareness-raising and the prevention of and response to GBV.

• Increase capacity-strengthening around feminist MEAL principles and the interlinkages between them, so that they are fully internalized among partners from the outset of a given project.

• Strengthen digital intervention strategies, in order to reach more young people both online and offline, while being mindful of the “digital divide” and ongoing need for paper-based SRH outreach initiatives.

• Undertake advocacy initiatives geared towards ensuring greater congruency and harmony between national-level policies (e.g. those related to health and education), in order to ensure that such policies speak to and reinforce rather than contradict each other.

MOZAMBIQUE

• Improve gender equity through giving greater consideration to the participation of men and boys in project activities.

• Ensure greater representation of men and boys in key evaluation moments.

• Integrate more national level advocacy activities, through leveraging partners’ networks and participation in technical working groups (e.g. those associated with the Ministry of Health), in order to strengthen the implementation of guidelines and recommendations for specific strategies pertaining to SRHR.

ZAMBIA

• When undertaking data collection (e.g. household surveys), take into consideration the school calendar period, in order to better reach the desired populations (e.g. AGYW). This is considered to be behind the challenge of reaching participating AGYW in the survey, as they were in school at the time of data collection.

• Increase sample sizes for key evaluation moments, in order to be able to draw more meaningful conclusions regarding the impacts of programming initiatives. Also undertake more direct and deliberate ways of ensuring a larger percentage of project participants participate in evaluation reviews, so program implementers have a clearer picture of the people who benefited from the project. Consider using a comprehensive database of project participants rather than partners’ separate databases, so that it is easier to track and target the same populations.

• Continue to scale up engagement with men and boys in SRHR programming, as well as economic empowerment initiatives for AGYW.

• As part of addressing stock management issues at health facilities, consider supplementing key or “high demand” FP commodities, so as to reduce the risk of increasing SRH demand without adequately improving the provision of SRH services.