The 468 SafeZone

Access to Sexual and Reproductive Health and Rights (SRHR) services is crucial to the health and well-being of young people globally. A 2020 study by the Obafemi Awolowo University Ife Press revealed that a significant portion of the local population of students faces barriers in accessing these essential services.

In the same vein, sexual violence in Nigerian universities is becoming an increasingly alarming issue and the lack of response centres in many universities in the country makes the problem worse. 

An investigation by BBC Africa in 2019 titled 'Sex for grades' shows that there is a high prevalence of sexual harassment in Nigerian universities. A study by Amnesty International in 2020 also documented several accounts of female students victimized by such acts.

Imagine how impactful it would be if every university campus housed centres where young people could access comprehensive SRHR services,  obtain judgment-free counselling, safely report instances of assault, receive emergency care, secure long-term support, and even pursue justice. Such initiatives would markedly improve the quality of life of young people, particularly adolescent girls and young women, in Nigerian universities.

The Nigeria Demographic and Health Survey (NDHS) reveals that fewer than 15% of women in Nigeria between the ages of 15-49 utilize any form of modern contraception. This alarming statistic suggests that 85 out of every 100 young Nigerian women lack access to this critical SRHR service. 

This contraceptive gap significantly contributes to the surge in unsafe abortions. A Guttmacher Institute study found that in 2012 alone, Nigeria saw approximately 1.25 million abortions, the majority of which were unsafe and resulted in severe health repercussions. Such staggering figures could be curtailed with improved contraceptive access.

The magnitude of this challenge is overwhelming. Countless survivors of sexual violence remain unsure of where to seek emergency care, support, and justice. Simultaneously, millions of young people in Nigeria and beyond are denied access to vital SRHR services such as contraceptives, STI treatments, and counselling.

The 468 SafeZone tackles these challenges by providing a youth-friendly centre where young people can easily access comprehensive SRHR services without fear of judgment.

The 468 SafeZone promotes and protects the sexual and reproductive health and rights of young people by providing peer-delivered, youth-friendly and accessible sexual and reproductive health and rights information, services and support to young people in a non-judgmental and exciting manner. 

Our solution has three major components:

 1. A 24/7 walk-in youth-friendly centre, the 468 SafeZone, where young people can freely access basic sexual and reproductive health and rights services including contraceptives, treatment for sexually transmitted infections (STI), and psychological first aid and emergency gynaecological care in the unfortunate case of sexual violence and rape. To ensure youth friendliness, SRHR services will be provided by health providers and staff who are </=30 years old.

2. A 24/7 helpline to support survivors of gender-based violence 

2. A functional helpdesk support team comprising medical, legal and mental health professionals that supervise the provision of medical and mental health care and legal support for survivors.

An average Obafemi Awolowo University (OAU) student spends at least 4 hours at the university health centre waiting to get care after suffering the harrowing experience of a sexual assault. She finally gets attended to in a general space with no privacy after being questioned by one healthcare worker after the other. She leaves the centre feeling unsure of herself and vowing not to tell another soul. 

Access to contraception and treatment for sexually transmitted infections are not left out as students have to suffer the judgmental looks of healthcare providers to access care.

Obafemi Awolowo University is home to over 30,000 students, many of whom are adolescents and young people between the ages of 15 and 24 years.

University students are one of the most vulnerable groups to sexual and reproductive problems such as unwanted pregnancies, sexually transmitted infections including HIV/AIDS, unsafe abortion and gender-based violence. This vulnerability is due to their curiosity about sexual experimentation which leads to a high level of risky sexual behaviors among University students.

As a result of this, young people require friendly, accessible and reliable sexual and reproductive health and rights services that meet their sexual and reproductive health and rights needs in a non-judgmental and inclusive manner. 

The 468 SafeZone has worked to bridge this gap by providing dedicated sexual and reproductive health and rights services tailored to young people’s unique experiences, shortening wait time, and providing guaranteed privacy, confidentiality, and access to trained professionals and services without discrimination. 

A study conducted at the Obafemi Awolowo University Teaching Hospitals Complex by Ijarotimi et al (2019) found 4% of the total deliveries to be from teenage pregnancies with almost double the mortality rate among them compared to the adult population. 

Olasode also found 72% of the patients receiving treatment for a sexually transmitted infection at the STI clinic to be students with a majority practising risky sexual behaviours. 

The concept of sexual and reproductive health, as well as, the uptake of services in this community must, therefore, receive urgent attention. 

In our experience as a helpline emergency response team at OAU, we have had a front-row seat to the barriers that prevent OAU students from accessing care and are actively working to create a safe, welcoming and friendly space for young women to access sexual and reproductive health services. We are working to provide OAU students with affordable and reliable services that reduce the incidence of unwanted pregnancies and STIs and encourage sexual violence survivors to seek care.

Our team, composed of three young women aged between 23 to 27, graduated from Obafemi Awolowo University recently. Each of us has had a first-hand experience of the challenges of SRHR service delivery on campus. As members and executives of the Campus Health and Rights Initiative, a youth-led SRHR advocacy group, we have encountered situations like unwanted pregnancies, untreated STIs, and gender-based violence. 

In response, we each developed innovative strategies to address these unmet needs. Two years ago, our team lead established the 468 helpline and helpdesk with support from team members and the advocacy group.

Our advocacy group consists of students, adolescents, and young people, actively involved in designing and implementing this solution. We also involved the target population by conducting surveys among students of Obafemi Awolowo University to understand their SRHR needs. 

The solution is primarily delivered by advocacy group members, who serve as peer health educators and support providers. Our proximity to the community, lived experiences and deep understanding of SRHR challenges in our university community uniquely position us to design and deliver this solution effectively.

Our 24/7 helpline services are available to all students of Obafemi Awolowo University:

1. We have provided SRHR education to a cumulative number of about 100,000 students over the past 2 years through our social media, educational websites, and outreach events.

2. We have supported 5 survivors of gender-based violence, linking them with needed professional medical and mental health care, and legal support

3. We have handled a case of post-abortal bleeding, linking the client to prompt post-abortal care and preventing further complications

4. Through our activities over the past 2 years, we have provided free HIV testing and counselling, and free contraception to over 10,000 students 

The 468 SafeZone is highly innovative as it integrates SRHR services and education with recreation and relaxation for young people, and leverages the use of digital technology to promote effective service delivery.The key innovative areas include:

1. A friendly SRHR service center in the university community

This multifaceted centre dedicated to improving sexual and reproductive health and rights will allow young people to have access to resources like music, games, movies and community, providing an enabling environment for meaningful conversations and engagement. Infusing recreation into basic SRHR services will also serve to reduce the stigmatization and reluctance associated with visiting an SRHR service centre. All services will be delivered by peer health educators and health providers who are also young (under the age of 30), ensuring that a friendly atmosphere is always maintained.

2. A toll-free helpline managed by peer health educators

The toll-free helpline makes it easy for young people to seek SRHR information from the comfort of their homes. It also makes it easy to report cases of sexual violence immediately.

3. Digital health

Digital health technology will be used for appointment booking, health records, and client follow-up. This will contribute significantly to the reduction of wait time and make client follow-up seamless.

In the next year, the 468 SafeZone at Obafemi Awolowo University will contribute to achieving SDG 3 by:

1. ensuring that 90% of young people on campus have easy access to affordable, and non-judgmental SRHR services available 24/7 for emergencies (in cases of sexual violence). We aim to reduce average wait times for non-emergency SRHR services by at least 50% compared to the existing university health services by employing the use of digital forms to schedule appointments. Through the helpline we aim to ensure immediate response to reported cases of sexual violence.

2.  Maintaining a provider attitude score of 4.5 out of 5, as measured by client feedback surveys by ensuring that SRHR services are provided by young professionals aged </= 30 years who have been trained to provide youth-friendly and non-judgmental services

3. Achieving a 30% increase in service delivery speed, and client follow-up through the use of helplines and digital health technology for documentation and health records.

In the next five years, the 468 Safezone will have successfully scaled its services beyond the Obafemi Awolowo University campus, establishing satellite hubs in student-dense locations off campus and extending its reach to multiple campuses across Southwest Nigeria. This expansion is projected to lead to a 50% increase in the overall accessibility of SRHR services for young people in the Southwest region.

 By effectively integrating recreation with SRHR services, the project will have positively impacted the overall well-being and empowerment of young people, contributing significantly to the attainment of SDG 3 targets in Southwest Nigeria

Inputs:

1. Human resources: Recruitment and training of a team of dedicated peer health educators, healthcare providers, counsellors, and support staff with expertise in youth-friendly SRHR services

2. Funding and Resources: Secure funding to cover operational costs, infrastructure development, training programs, and technology implementation.

3. Partnerships and Collaborations: We have existing partnerships with the gynaecology and mental health departments of the Obafemi Awolowo University Teaching Hospital, the Centre for Gender Studies and Development in the university, and the Gender Mobile Initiative. These organizations provide expert guidance, technical support and legal representation in our work. We plan to partner with NGOs and social enterprises like the UNFPA and DKT for funding and procurement of consumables.

4. Technology Infrastructure:  a robust digital platform for client management, scheduling, documentation, and follow-up.

Activities:

1. Establishment and development of the 468 Safezone, the first youth-friendly SRHR service centre on campus, equipped with state-of-the-art facilities for SRHR services and recreational activities.

2. Development of standardized protocols for service delivery, counselling, and recreation integration.

3. Service Expansion to Other Campuses and Locations:

   1. Identification of student-dense locations outside the OAU campus and replication of the 468 SafeZone model, ensuring accessibility and cultural sensitivity.

   2. Establishment of the 468 SafeZone in other universities in southwest Nigeria and  partnerships with local student organizations and the university authorities

4. Training and Capacity Building: regular training sessions for providers and peer health educators on inclusive youth-friendly SRHR services, non-judgmental attitudes, and recreational integration.

5. Helpline Implementation: Scaling of the established helpline by making it toll-free and self-serviced for quick access to information, counselling, and appointment scheduling.

6. 24/7 availability and adequate training of staff to handle inquiries effectively.

7. Community Engagement and Awareness: Hosting of small-sized, cosy workshops at the 468 Safezone to hold conversations with young people about their sexual and reproductive health and rights

Outputs:

1. Increased Accessibility to SRHR services

1. Significant reduction of wait times for SRHR services leading to quicker and more efficient care.

2. Improved Provider Scores: Trained providers who are also young people, creating a safe and welcoming environment for other young people

3. Efficient Documentation and Follow-up: Digital technology ensures accurate record-keeping and streamlined follow-up procedures for clients.

Outcomes:

1. Empowered Youth:

Young people are equipped with the knowledge, skills, and resources to make informed decisions about their sexual and reproductive health, leading to improved well-being and autonomy.

1. Broader Regional Impact:

Successful replication of the 468 Safezone will expand access to youth-friendly SRHR services across Southwest Nigeria.

Impact:

The 468 Safezone contributes to achieving SDG 3 by improving the overall sexual and reproductive health outcomes of young people in Southwest Nigeria. This includes reducing maternal mortality,  preventing STIs and unwanted pregnancies, and improving emergency response to rape and other forms of gender-based violence

Full time strategic team: 3 people

Part time peer health educators: 30 people

Two years

Incorporating diversity, equity, and inclusivity is fundamental to our project's success. Our leadership team consists entirely of young women aged 24 to 28, reflecting a diverse range of perspectives and experiences. We graduated from Obafemi Awolowo University, which is known for its very diverse student body, representing young people from all tribes and geopolitical zones of Nigeria. This diversity equips us with a nuanced understanding of the varied SRHR needs within our target population.

Furthermore, our team works directly with a group of peer health educators selected evenly across the different faculties on campus. We have also initiated outreach programs to involve students with diverse cultural, socioeconomic, and educational experiences, ensuring a holistic approach to SRHR service delivery.

Additionally, we are committed to providing ongoing training and workshops to our team members and peer health educators, focusing on cultural competency, sensitivity, and inclusive practices. This empowers us to approach SRHR issues with a greater understanding of intersectionality, ultimately leading to more effective and tailored solutions.

By fostering a culture of openness, respect, and active listening, we aim to create a safe space for every young person, ensuring that their voices are valued and integrated into our decision-making processes. We recognize that true inclusivity leads to more comprehensive and sustainable solutions for the SRHR challenges faced by the diverse young population we serve

Our solution utilizes a social impact business model where we focus on improving access to sexual and reproductive health and rights services among young people in Nigeria. Our business model ensures that we deliver value to both the beneficiaries and stakeholders while also ensuring that it is sustainable.

Here is a breakdown of the model:

Customer segments

• ‌ Undergraduate students of Obafemi Awolowo University Ile-Ife, Nigeria. They benefit from access to SRHR education, contraception, treatment of STIs, post-rape care and long-term support for survivors of sexual violence.

• ‌Neighbouring communities: Through the 468 Safezone located off campus, other young people in Ile-Ife and its neighbouring communities will benefit from increased knowledge and awareness about SRHR. We educate, train and work with young student groups to be Peer Health Educators and Advocates in their communities.

Value proposition

• Comprehensive, youth-friendly SRHR services integrated with recreation,  reduced wait times, non-judgmental attitudes, and affordability.

• Effective and prompt sexual violence Response: 24/7 helpline and walk-in response centre providing medical, legal and psychological support for survivors of any form of sexual violence, focusing on immediate emergency care and psychological first aid 

• SRHR Education and Counseling aimed at empowering young people to make informed choices about their sexual and reproductive health and rights.

• Accessible, non-judgemental and affordable treatment of STIs using Nigeria’s adaptation of the WHO syndromic management approach

• Comprehensive contraceptive and Family Planning Services in a youth-friendly and accessible setting.

• Community Participation, training and engagement of young people as peer health educators, laying the foundation for successful careers in SRHR advocacy.

• Revenue Generation

• Fee-for-service model for SRHR consultations, screenings, and procedures including highly subsidized digital  subscription cards, and service charges 

• Donations and grants from government, NGOs, and private organizations supporting SRHR initiatives.

• Fee-based workshops and training programs for external stakeholders.

Partners and Key Stakeholders

• Corporate Partners: Gynecology and mental health departments of the Obafemi Awolowo University Teaching Hospitals Complex, Gender Mobile Initiative, Legal Practitioners, Center for Gender Studies OAU. Prospective partners include the UNFPA 

• Community leaders: The management of the Obafemi Awolowo University and other universities, and the student union government

• Donors and international sponsors

Cost Structure

• Staff salaries and training costs  

• Facility maintenance, health consumables and operational expenses.

• Technology infrastructure and maintenance.

• Marketing and awareness campaign costs.

Identified Gaps

• Need for a safe space for survivors of sexual violence

• Lack of access to contraceptives and family planning services

• Need for treatment of STIs in a friendly and nonjudgmental approach

Impact Metrics

The number of young people served.

Wait time reduction percentage.

Client satisfaction scores.

The number of successful interventions (e.g., prevented pregnancies, met need for contraception, treated STIs, etc.).

Expansion metrics (number of satellite hubs, campuses reached, etc.).

To achieve financial sustainability for the 468 SafeZone, we will adopt the following approaches:

1. Diversified revenue models: A. Fee-for-Service Model: We will generate revenue by charging affordable fees for SRHR consultations, screenings, and procedures. We will also offer a range of bespoke and different service packages to cater to varying needs and budgets. An example is the sales of exotic sexual health products like flavoured condoms, lubes, and hygiene products.

   B. Workshops and Training Programs: We will conduct fee-based workshops and training sessions for students of the university who want to earn certificates in peer health education, SRHR advocacy and program design. 
   
   

   C. Donations and Grants: We intend to seek funding through government grants, NGOs, private organizations, and philanthropic individuals who support SRHR initiatives.
   
   

   2. Cost Management:

1. 1. Operational Efficiency: We intend to Implement cost-effective operational strategies, such as the use of digital technology for documentation and client follow-up to minimize administrative and stationery expenses.

   2. Engagement of volunteers: We intend to engage our volunteer peer health educators to offer support services such as administration, facility management and helpline management

   3. Cost-effective staffing: As part of our plan to ensure cost-effectiveness, we will employ healthcare providers through the National Youth Service Corps Scheme, a one-year community service for recent Nigerian graduates. The government pays stipends to Corps members, significantly reducing our expenses on their salaries

   4. Staff Training and Retention: While keeping our staff members to the most effective minimum, we will Invest in the training and development of staff to enhance productivity and optimize resource allocation.
      
      

      3. Monitoring and Evaluation: We will regularly assess the financial performance of the 468 Safezone against predefined key performance indicators (KPIs) to identify areas for improvement and adjust strategies as needed.