Tariro (Hope) for Adolescents with Disabilities

Promoting inclusive access to SRHR information and services to adolescents in their diversity (disability, religion, sexuality) in Kwekwe, Zimbabwe.

Adolescents, particularly girls, face a multitude of barriers to enjoying their sexual and reproductive health and rights (SRHR), including: lack of access to relevant information and lack of youth-friendly services, such as for contraception, STI diagnosis and treatment, and they experience poverty, sexual and gender based violence (SGBV), stigma and discrimination. Too often, efforts to address adolescent health focus uniquely on changing the behaviour of girls and fail to address these underlying barriers. Driving all of these challenges faced by adolescent girls are harmful religious, cultural and social norms and beliefs, which limit their access to political, social, health, educational and economic opportunities and spheres.

In a 2014 survey by Zimbabwe’s National Statistics Agency, one in three women 20–49 surveyed reported marriage before age 18; an estimated 4% marry before age 15. The harmful effects of early and forced marriage on girls’ health (girls younger than 15 are five times more likely to die in childbirth than older females), education, HIV vulnerability (girls in age-disparate relationships have higher HIV risk), and wellbeing (child brides are more likely to describe their first sexual encounter as forced) are clear. Regarding violence against women, data from the 2015 Zimbabwe Demographic and Health Survey (ZDHS) shows that 35 percent of women and girls aged 15–49 had experienced violence sometime in their lives. Rates of gender based violence and violence against children are high in Zimbabwe, as 1 in 3 children experience abuse before 18 years of age and one third of females experienced sexual violence before the age of 18. Zimbabwe has the sixth-highest number of annual adolescent AIDS-related deaths in the world and HIV prevalence is almost twice as high among females 15–24 as among men and boys of the same age.

The challenges faced by adolescents girls and young women especiall those with disabilities and key populations (young girls and women selling sex, LGBTQi+, sexually exploited adolescents) have always been there but were execabated by COVID-19 pandemic. According to Plan Zimbabwe’s Gender and SRHR rapid assessment report on the effects of COVID-19, March 2020, gaps for SRHR in the health system in Zimbabwe were exposed during the response lockdown period within its response to ensuring comprehensive quality health care delivery.

• Working to address harmful religious, cultural and social norms and beliefs will enable men and traditional leaders to be partners in promoting women’s human rights (in their diversity: with disabilities and key population) thereby making women enjoy their rights from grassroot level.
• The project will address lack of access to relevant information and lack of youth-friendly services, such as for contraception, STI diagnosis and treatment, and they experience poverty, sexual and gender based violence (SGBV), stigma and discrimination. This will enable adolescent girls and young women especially those with disabilities and key population to enjoy their sexual and reproductive health and rights (SRHR)
• Maintaining the status quo will benefit the patriarch (men at all levels) as it will wield power to abuse adolescents girls and young women especially those with disabilities through transactional sex for the girls to afford basic SRHR services like sanitary pads, contraception, STI diagnosis and treatment. 
• Absolute power remains with patriarch (men and boys) as the society dictates and the girls and young women will exercise Power With to influence the changes the project envisaged.
• The project will work with boys and men as partners through awareness campaigns, community and policy dialogues to make sure they support the girls access to SRHR information and services.

The solution targets underserved adolescent girls and young women in their diversity especially those with disabilities in the rural areas of Kwekwe district of Zimbabwe. These include those in and out of school who are caught up in the web of and at risk of child marriages and unplanned pregnancies, HIV and gender dimensions. This intersectionality results in triple burden of girls and young women. These groups have very limited access to SRHR information and services because they are women (gender), it is not important for them to access services (social norms), and distance to health facilities (structural).

• By addressing the underlying causes of exclusion (harmful religious, cultural and social norms and beliefs), which limit girls and young women access to political, social, health, educational and economic opportunities and spheres, the project would have created an opportunity for the empowerment of girls at a broader spectrum.
• By addressing the underlying challenges mentioned, the project will create youth friendly service provision translating to a sustained empowerment of girls and young women to be in charge of their SRHR rights and enjoy the right to choose SRHR services of their choice.

The team is made up of members with diverse skills and experiences like social work, psychology, finance, administration and information technology. The team is under the leadership of the organisation.

• The organisation has the largest number of persons with disability in Zimbabwe and has expertise and experience working with persons with disability in SRHR issues.
• Being led by women with disabilities, the organisation can better address the issues affecting women with disabilities.
• The organisation’s Board Chairperson (President) is a former Senator representing persons with disabilities in the Upper Chamber of Parliament. This gives the organisation some leverage in influencing policy change through speaking truth to power.
• The organisation is a cross disability organisation working with all types of disabilities meaning we will involve all girls and young women with disabilities regardless of the type of disabilities.
• The organisation has members who are key populations (sex workers and LGBTQi+) meaning it will be a lot easier to mobilize the key population.
• The organisation has been working with duty bearers in advancing the rights of persons with disabilities making it easier for the organisation to influence changes in social norms.

The organisation works with persons with disabilities and through interaction and requests from community members, this request was coined. There was no official research but consistent requests resulted in the organisation identifying the needs then set up this Tariro Team.

The solution's innovation is two-fold:

• The use of android mobile application which will be developed and named Tariro SRHR App. This will be loaded with SRHR information on the go. It will have a chatbot that will help sift information according to the needs of the user. It will have a built in access to a social worker for referral to services.
• The making of re-usable sanitary pads will be the other innovation where 1000 adolescent girls and young women will be trained to make sanitary pads. This will bridge the unmet needs of sanitary towels at a much lower costs as an individual will need just 3 pads to last a year.

The goal of the solution will be:

Children, adolescents and youth in all their diversity have control over their bodies and futures in a healthy, safe and supportive environment. 

The results will be:

• children, adolescent and youth in all their diversity have improved skills and access to quality, inclusive, gender-responsive and adolescent- and youth-friendly SRHR services information and especially girls most at risk to have stronger social protection before, during and post emergencies.

At each community, health centre staff will be capacitated to establish timely, safe and confidential referrals for adolescent and young people particularly girls and young women, pregnant girls and young mothers on primary maternal health care as needed. The focal point staff will be trained in climate risks, disaster risk reduction, action planning (including training drills/simulations) and contingency planning to enhance continued SRHR/SGBV service delivery during emergencies and establishment of quarterly health facility led DRR, action and contingency plans review meetings inclusive of adolescents and young people and community representatives. 

• Children, adolescent and youth in all their diversity have the support and the confidence to make informed, responsible, positive and healthy choices about their SRHR and future before, during and post crises.

Solution will work with community based youth leaders or mentors to engage young people, providing them with correct information, challenging them to look at their own attitudes and behaviours as well as helping them to develop the skills they need to adopt health behaviours and to remain safe. Traditional leaders, religious leaders and parents will be engaged through sessions aimed at positively influencing gender and social norms for easier CSE delivery. - making of re-usable sanitary wear; -intergenerational dialogues; -use of SRHR App.

• Activities

The project will adopt the combination of intersectionality and twin-track approaches to address the SRHR, disability exclusion and social norms challenges mentioned on number 9 above. NCDPZ’s proposed methodology and technical approach for achieving the outcomes and results draws on expertise gained from implementing gender transformative and sexual and reproductive health interventions in Zimbabwe and from recent efforts to align our health programs with the UNAIDS 95-95-95 goals and the Extended Zimbabwe National AIDS Strategic Plan (ZNASPIII).  The following are proposed activities:

 Development of the Tariro SRHR Android App

• Quarterly Disability Fare
• Stop the Bus Campaigns
• Community Dialogues
• Policy Level at Provincial Level
• Evaluation

The COVID-19 pandemic eroded household income and savings resulting in the majority living below the poverty datumn line. Families have no means to provide for menstrual hygiene management for girls and young women with disabilities. The project will procure and distribute sanitary pads to 600 girls and young women with disabilities for 6 months as an emergency measure while they are being taught to make their own re-usable pads.

To address the issue of limited access to SRHR information and services, the project intends to partner with Zimbabwe National Family Planning Council (ZNFPC) and provide free SRHR information and services to adolescents and young women with disabilities and key populations aged beteen 15 and 29 years. These will be done once per quarter for 2 quarters in underserved rural communities of Kwekwe district.

Conduct 2 Stop the Bus Campaigns to increase access to reporting of SGBV and access to multi-sectoral SGBV response services in underserved areas. The project will take advantage of the campaigns to disseminate disability sensitive SRHR IEC material for adolescents and yougng women with disabilities (sensory, mental, and physical) including the key populations. The project will develop and share with all adolescents, including those with disabilities a Referral protocol for structured referrals for inclusive, gender responsive information and services.

Lead dialogues with duty bearers at community level to discuss harmful religious, cultural and social norms and beliefs, which limit their access to political, social, health, educational and economic opportunities and spheres. These will involve discussions between adolescent girls and young women with disabilities, and traditional, religious leaders and parents. The engagement with adolescents will focus on improving knowledge, influencing attitude change and developing behaviours and practices consistent with healthy, equitable and supportive intimate relationships among adolescent boys and girls. The dialogues will be done once per quarter for 2 quarters.

Lead dialogues with Policy makers on policy barriers to uptake of SRHR services by girls and young women with disabilities especially those who are key populations, such as Age of Consent,  user fees and other key issues such as termination of pregnancy, child marriage, SADC model law, implementation of national and regional commitments on Sexual and Reproductive Health. The project shall hold one dialogue where adolescents girls and young women with disabilities will meet Provincial Minister of State for Provincial Affairs, Provincial Medical Director, Zimbabwe National Family Planning Council, Ministry of Primary and Secondary education, Ministry of Women Affairs, Department of Social Development and Chiefs.

The project will institute an end of project evaluation to document lessons learnt, effectiveness and sustainability of the approaches adopted.

The solution's technology is two-fold:

• The use of android mobile application which will be developed and named Tariro SRHR App. This will be loaded with SRHR information on the go. It will have a chatbot that will help sift information according to the needs of the user. It will have a built in access to a social worker for referral to services.
• The making of re-usable sanitary pads will be the other innovation where 1000 adolescent girls and young women will be trained to make sanitary pads. This will bridge the unmet needs of sanitary towels at a much lower costs as an individual will need just 3 pads to last a year.

The solution will reach 1000 direct beneficiaries as follows:

• adolescents girls and young women with disabilities: 330
• without disabilities: 660

Zimbabwe is gearing towards general elections mid year 2023. History has proven times without number that elections in Zimbabwe will be marred by violence. As such, the solution might be delayed to implement especially field based activities like dialogues during the election periods.

The solution will work with Zimbabwe National Family Planning Council to provide SRHR services like family planning, HIV testing, campaigns and other SRHR services

The business model is based on health-income intersectionality where the solution will link participants to access services thereby reducing the unproductive hours of the most agile group (adolescents and young people). It will train them in re-usable sanitary pad making and sell to others. The proceeds realised will be saved through internal savings and lending clubs where they will be borrowed for an interests. The interest will be invested in other projects like poultry and goat which will allow for income security.

The sale of re-usable sanitary pads will enable the participants to engage in internal savings and lending until they start other ventures like poultry production.