At today’s IGHN Conference, GOAL’s Global Health Experts demonstrate how the aid agency’s R4S approach helps strengthen resilience in systems in fragile contexts and vulnerable communities.

GOAL recognises that societies comprise socio-economic systems which service the needs of their populations. They also understand that addressing recurrent crises and building resilience requires an integrated systems approach coupled with Social & Behaviour change.

In the context of the humanitarian sector, where systems are fragile and significant portions of the population are socially or economically marginalised, communities are highly vulnerable to external shocks and stresses. Therefore, coordination among stakeholders to strengthen these systems will enhance resilience and contribute to sustainable development.

In the R4S approach, there are five components:

• Identify and select critical socio-economic system(s)
• Map the status of selected socio-economic system(s)
• Identify principal risk scenarios with potential to impact the selected socio-economic system(s)
• Analyse resilience and synthesis of selected socio-economic system(s) considering six Determinant Factors of Resilience (DFRs)
• Conduct participatory monitoring, evaluation, accountability, and learning.

Speaking in advance of her presentation at the two-day IGHN Conference, Marie Hallissey, GOAL’s Global Health Advisor, explained,

“GOAL has developed detailed R4S maps of the Sierra Leone and South Sudan health service delivery system. We have used this mapping exercise to ground our health programme design by examining core service delivery channels between service providers and users, supporting health system functions, regulatory functions, health behaviours and social norms. This has helped focus our programme interventions to support the permanent actors for system change.”

 GOAL’s presentations to the IGHN Conference also focused on Sierra Leone (SL), which has one of the highest rates of adolescent pregnancy in the world. According to the latest SL Demographic and Health Survey, 21% of girls in SL between the ages of 15 and 19 were childbearing, and 29.6% had married before 18. The high prevalence of adolescent pregnancy also contributes to high maternal mortality.

Between 2018 and 2022, the GOAL SL team implemented an Adolescent Sexual Reproductive Health (ASRH) programme using a systems approach combined with Social Behaviour Change Communication (SBCC) interventions to address high adolescent pregnancy and maternal mortality and associated mortality rates. The health system strengthening analysis that was used identified service gaps across the primary health care system, allowing the programme to focus on mentoring clinical staff for the provision of quality and confidential ASRH services at 63 target health care centres, while SBC communication increased the awareness, knowledge, skills and confidence of adolescents.

Also speaking in advance of her presentation at the IGHN Conference, Geraldine McCrossan, GOAL Global Health, SBC and Policy Advisor, said,

“Our evaluation of the ASRH programme in Sierra Leone found that the programme had contributed to strengthening the quality and responsiveness of ASRH services and that engaging young people and key influencers around adolescent pregnancy led to positive changes in attitudes and shifts in social and gender norms, increased uptake of modern contraception among female youth from 38% to 58% (15-19yrs) and from 26% to 71% (20-24yrs) and reductions in adolescent pregnancies in the target communities^[1].

“GOAL is now supporting district health management teams in three districts in Sierra Leone to scale up this approach to deliver on sustainable change in the sexual and reproductive health system and transformative change around social and gender norms.” continued Geraldine McCrossan.

 GOAL Strategy 2025 is titled From Crisis to Resilience, recognising that more must be done to move vulnerable populations exposed to humanitarian crises and disaster hazards, particularly those living in fragile and conflict-affected contexts, beyond humanitarian crisis and to achieve greater resilience. Key to this is strengthening local capacities by stabilising and supporting local systems and populations, as evidenced in the GOAL pandemic-related response. Please see https://www.goalglobal.org/strategy2025/

The Irish Global Health Network (IGHN) is an independent network of people from diverse backgrounds, sectors and disciplines who are concerned with health inequities and issues that impact the health and development of populations at a global level, with a particular commitment to those living in middle and low- income countries. GOAL is proud to be a long-standing member of the IGHN and one of the 2024 Conference sponsors to support learning and sharing on global health issues.   Please see https://globalhealth.ie/

References

• Sierra Leone, Demographic and Health Service 2019. https://dhsprogram.com/pubs/pdf/FR365/FR365.pdf
• Supporting reproductive health choices and empowering adolescents: an example from GOAL’s Siera Leone Irish Aid Programme 2018- 2022