Our third and final episode of the season will highlight some tools and resources to help us ensure that policies and programs are more inclusive and accessible to all.
www.knowledgesuccess.org/inside-the-fp-story
From Knowledge SUCCESS and VSO, this is Season 5 of Inside the FP Story—a podcast developed with the family planning workforce, for the family planning workforce.
Each season, we hear directly from program implementers and decision makers from around the world on issues that matter to family planning programs. Through these honest conversations, we learn how we can improve our family planning programs as we work together to build a better future for all.
I’m Sarah Harlan, Partnerships Team Lead with the Knowledge SUCCESS project. I’m pleased to introduce our narrator, Charlene Mangweni-Furusa.
Narrator: This season on Inside the FP Story, we have been exploring the topic of intersectionality in the context of sexual and reproductive health programs.
On our first episode, we defined intersectionality and introduced the key challenges and opportunities of using this approach. We also heard from Make Way program staff about their innovative application of intersectionality to global FP and SRH programming.
For our second episode, community members from Kenya, Uganda, and Rwanda shared their experiences. Two health providers offered insights on the intersecting identities of the communities they serve, and three women seeking sexual and reproductive health services discussed how their identities shape their ability to access the care they need.
The diverse perspectives shared in the second episode helped us understand why an intersectional approach is necessary to break down barriers to SRH services. But once we realize the importance of doing this work, where do we begin? Our third and final episode of the season will highlight some tools and resources to help us ensure that policies and programs are more inclusive and accessible to all.
Narrator: “Intersectionality” is an approach for understanding how aspects of an individual’s social and political identities combine to create different kinds of discrimination and privilege. This is a crucial approach for SRH programs—it can help us plan programs and services in a way that leaves no one behind.
As we learned during the previous two episodes, the Make Way program uses an intersectional approach to work directly with underserved communities—especially young people—to stand up for their rights and improve access to SRH services. And a key focus of the Make Way program is to make intersectional tools available to all who want to do this work.
So where can you begin if you are new to using the intersectional approach within SRH programs? We suggest starting with the Make Way SRHR Toolkit.
This Toolkit takes civil society groups and organizations through the process of advocating for a more intersectional approach to SRH. It breaks down the process into nine steps—starting with the fundamentals of intersectionality, an analysis of the issue, and advocacy goals and objectives. It then guides users through coalition-building, stakeholder mapping, and developing an advocacy plan. The final three steps involve developing a communication and media strategy; implementing the advocacy plan; and monitoring and evaluating your work.
This user-friendly online resource includes a comprehensive set of tools, providing SRH advocates with practical templates, guidelines, assessments, and exercises to use as they apply an intersectional approach to their SRH programs. Some tools help build an understanding of the concept of intersectionality or help clarify values. For example, the Meaningful Youth Engagement training guide has already been used by the Break Free Alliance to ensure the inclusion of youth voices in their work preventing child marriage and adolescent pregnancies. Other tools are useful in other areas such as policy, budgeting, and community engagement. For example, the policy analysis tool was used to develop a bill aiming to secure SRH services, which was introduced to the East African Community’s Legislative Assembly in 2021.
We will not describe the entire contents of the Toolkit on this podcast, but we encourage you to visit and refer to it regularly when you apply intersectionality to your work. You can find the link to the Toolkit in the notes for this episode.
The remainder of this episode will focus on a recently-published tool that is particularly useful for intersectional work in SRH—The Intersectional Community Scorecard.
Narrator: The Intersectional Community Scorecard, developed by the Make Way program, promotes the engagement of young people in the decision making process. Specifically, it focuses on making space for youth with multiple, overlapping identities that increase vulnerability to stigma, discrimination, and violence—for example, those with disabilities, living with HIV, or who identify as LGBTQI+—and gives them a platform to interact with duty bearers and power holders in their community. A note that “duty bearers” is a term that refers to those who are mandated to offer services within their country, region, or locality. Examples of “duty bearers” are local authorities, ministries, parliament policymakers, police, teachers, and health workers.
The Community Scorecard targets three main outcomes: First, the young people must be at the center of the process, and must shape the design, objectives, activities, and outcomes related to using an intersectional approach in SRH. Secondly, the core activities must be undertaken with the meaningful and consistent participation of these youth. And finally, their SRH needs—including improvements in availability, accessibility, acceptability, and quality of SRH services—should constitute the main expected outcomes of the Community Scorecard process.
To hear more about the Intersectional Community Scorecard, we spoke with Sammy Obara, Make Way program coordinator with VSO Kenya. Specifically, he works on SRH issues with young people ages 12 to 24 years old in Kenya.
Sammy started out discussing Make Way’s focus on youth and intersectionality, and why the scorecard is needed for SRH programs and services.
Sammy Obara: At the policy level, we're looking at working with youth at the margins. We're looking at youth who are disadvantaged, either by their geographic location, social economic class, having a disability, either having other multiple identities like [being] HIV [positive], sexual orientation, faith or religion. And what we are trying to do is to sensitize service providers to have an intersectional lens when they're designing the services, at the design level. How do you design inclusive services? You must involve all the people in the catchment area. So you must understand your catchment area as a service provider. Not every catchment area is the same. We know that the service providers had a training centralized. But when you are sent to deliver services, you must be sensitive to your catchment area. That is one.
Two, you must involve your catchment population in the services you provide. Three, you must understand the language and the culture and be sensitive in terms of the language you use, the symbols you use, and how you communicate so you are inclusive. So it's a process in terms of the design and delivery. We are talking about the issue of the right of feedback. How do we create a safe space for feedback? And the community scorecard provides that safe space for feedback.
Narrator: The scorecard places youth with multiple, overlapping vulnerabilities at the center of a community’s efforts to make SRH programs and services more inclusive.
In addition to providing a safe space for feedback, Sammy also explained how the scorecard addresses power imbalances—which is a key principle of the intersectional approach.
Sammy Obara: Power and voice plays a key role in the design of inclusive services. And therefore, if you're able to involve the right holders and the duty bearers to discuss whether their objective is to improve the service, not to muscle one another to demonstrate who has the power, who has the resources. But the design, the orientation…Why the scorecard mechanism is designed is to ensure we are integrating against all those dynamics. How is this done? Let these groups in, have exclusive groups discussing together, but then bring them slowly to start exploring the problem and the solution. So at the end of the day, we are saying that we have a problem, but we also have a solution. And therefore, both of them own the problem and own the solution.
Narrator: So how do these groups—some of whom have power to create policies and programs, and others who do not—discuss solutions for SRH issues in a community? Make Way includes six steps in their Community Scorecard. Users can also find visual exercises and tips to ensure that this process is systematic and that the most marginalized and underserved groups within a community can fully participate.
The first step of the Community Scorecard process is preparation and formative work. This involves a context analysis of root problems and issues, a stakeholder mapping exercise, a safety analysis (to make sure all participants are safe in participating in this activity). It also includes mobilizing all the stakeholders you will invite to participate in this activity.
The second step aims to build the capacity of youth with compounding vulnerabilities. Make Way works to strengthen the capacity of young people about not only their rights and entitlements related to SRH, but their capacity to actually facilitate this scorecard process.
Then, in step three, these young people evaluate their ability to access and participate in SRH programs and services.
Step four is where duty bearers—and traditional power holders—self-evaluate how they involve people with various identities, especially young people, in SRH programs and services.
Step five is the face-to-face meeting, in which the duty bearers and the young people are brought together to discuss the issues they generated during their self-evaluation exercises. They discuss their scores, and agree on a collective response to community challenges.
Finally, step six involves joint action planning, budgeting, and follow-up. As mentioned earlier, youth who face compounding vulnerabilities are involved as leaders in each step of this process.
It may be difficult at first for young people—especially those with identities that are marginalized—to interact with powerful leaders in their communities. We asked Sammy what facilitators can do to make sure that each of the participants feel comfortable participating in this Community Scorecard Exercise.
Sammy Obara: Of course, there will always be challenges manifesting either because of the age gap, the gender, the sexual orientation [of participants], so it requires a deliberate effort on the facilitator to ensure that all these dynamics do not end up marginalizing any of the players or giving an unfair advantage over another. So it's a process.
Yes, I think the first important thing is you as a... a facilitator to understand your own bias-ness. That is the first thing. And therefore to be conscious of your bias-ness and your position of privilege as a facilitator. And this is done deliberately by creating an opportunity for one, is you ensure that when you start, you inform your team about their rights and privileges and the right of feedback. So you start by creating an enabling environment. But also you create safe spaces [with] various groups being together, and with various facilitators, which becomes crosscutting. For example is, by age, young people may look at me as a barrier, and therefore, I need to ask, we need to ask them whether they feel it will be a barrier. And if they say yes, then we get a young person who can fit in that. That is one, so being age sensitive, culture sensitive, disability sensitive, and also giving the audience [XX] to make sure they're comfortable with who will be the facilitator. So we have a range of facilitators in the community scorecard, and we distribute ourselves appropriately to make sure we're achieving maximum results.
Narrator: Sammy also talked about the importance of cross-cultural communication.
Sammy Obara: I think one of the key things that we were taken through is the intersectional model is the sensitivity to around what we call cross-cultural communication. And based on this, this training helps you understand how you communicate with various groups and various geographical settings. Some of the examples could be inappropriate, some of the words you use could be inappropriate. So sensitivity to language use is very important, depending on the context you are in. Sensitivity to your own voice. Because when I raise my voice, I may be communicating something different to various people, it may be also intimidating. And therefore, I need to keep on asking my audience whether my voice is intimidating, and how can they feel safe. So you keep on using your audience as a mirror to help you communicate and ensure you are in a situation where the communication should be friendly, should be engaging, should be mutual. So this is a process, but a sensitivity to all of those variables is very important that we are taking through during the training. But also again, as I have said, is the issue of sensitivity to other groups' values, is very important as we engage with various groups.
Narrator: He also talked about the use of religious texts that help affirm the values of all participants as human beings.
Sammy Obara: So we encourage the faith leaders to start with empowering scriptures from the Bible, or from the Quran. Scriptures that talk to issues of sexuality but in a way that affirms the humanity and the dignity and the value of being a human being. And therefore, Kenya being a faith-based, being by and large religious. So when we start with a prayer or a sharing of the scripture, we must affirm the values of what I have talked about.
Narrator: Although facilitators often start out the meetings affirming each participant as a human being—and trying to reduce the power imbalances—Sammy noted that power differentials often come through even in the process of self-assessment.
Sammy Obara: I think the interesting issues is how different groups will score. You'll find that the politicians will score themselves very highly, the service providers by and large will score themselves—and it's a process. When their supervisors are there, they'll be very cautious. When they're alone, you'll get different scores. The community will give them I think the reality check about the services they get. And never will get a debate of all these variables. But the interesting bit is that the communities that are facing multiple identities. You will find for example we have heard a challenge that in the health facilities, there are no sign language interpreters. And that is a gap. In the health facility, there might be no services that are friendly for young people so basically, you'll find various people scoring differently, but the community will always give the reality check. And they can also be a moment of tension for the start, but at the end, all of them will end up with mutual understanding.
Narrator: We asked Sammy to share examples of ways that SRH programs have been changed or adapted after using the community scorecard.
Sammy Obara: The findings have informed the following. One, to ensure that the services are delivered are that of quality. Two, it has informed the issue of the range of services available, based on the location of resources. And then three, the scorecard process has been able to identify the gaps available in the health system. Four, it has also brought out the issue of the importance of government leadership within the health facilities because you'll find you may allocate the same resources to different facilities at different areas with the same catchment population, but leadership of the health facility plays a key role.
So we use this for advocacy at the county level and at the national level. At the county level we use that because they're the managers and they can improve. At the national level, we use this as a case study model. That way, we can ensure a case to demonstrate evidence for the increase of resources for the health system. But also we can also use this to look at the limitations around policies and guidelines, and how they can be improved. So they provide us evidence for advocacy from the point of the end user. And also at times, we carry these voices, we carry these communities, some of them into the policy space to share their lived experience.
Narrator: In using this Community Scorecard, participants work together to identify issues to address in their advocacy work. They discuss a range of sexual and reproductive health services—including family planning, HIV testing and counseling, demonstration and distribution of condoms, screening and treatment for sexually transmitted infections, postabortion care, and more. And while their learnings differ by location, they often gain insights related to financial needs, accessibility needs, and knowledge gaps that can inform their advocacy efforts among country governments.
For example, this process may uncover some barriers—for example, negative community attitudes towards certain methods of contraception, or prejudice against LGBTQI+ youth seeking SRH services. It can also uncover some opportunities—for example, providers and centers that are friendly towards those with marginalized identities.
Sammy made it clear that the Community Scorecard provides a platform for voices that are often marginalized—this process allows these voices to be heard, and for their stories to inform policies. While data is important for policy change, stories can be even more powerful.
Sammy Obara: We have also showcased voices whereby we take the young people with a disability, with multiple gender identities to bring them to the policy space at the table, and they discuss with the policy makers. And that has been part of the changing moments, whereby you have these people discussing in the policy space at the national level. When they talk, it carries weight, and it carries influence. And that is our learning. So lived experience is one of them, but also the documentation of good case studies, from what is emerging from the Community Scorecard and use them for advocacy at the national level. We've also been able to use that. And people have listened to that... We have just come up with a new video on intersectionality. We also want to showcase that as part of the voice in advocacy.
Narrator: A link to the video Sammy mentioned is included in the notes for this episode.
We asked Sammy what he has learned by using the Community Scorecard—and how this has informed his work in intersectionality.
Sammy Obara: One is what I could call is the "power over" syndrome in decision making. The community scorecard has really helped us understand the power dynamics, and how the government carries a lot of power and influence, and they don't want to share that space with others. How have we been able to go about it, is I think, we start by negotiating with the power holders. You start with the most powerful ones, and you engage them on the benefits of providing quality services and the benefits of strengthening the voice of those you are working with. The benefits of how do we define community participation. So the scorecard model has helped us. It helps leaders, especially in the two counties in Kenya—Makueni and Kalifi—to come up with a good model of community participation that focuses on different variables. Youth, women, leaders, and religious groups, and professional groups. You don't combine them. Let each group be its own, and let each group be in a space [where] they feel comfortable. Meet them where they're comfortable, and engage them from their point of understanding. So it has given us a good mechanism on how we can strengthen governance in terms of participation but also in terms of mainstreaming of power into policy making process at the grassroots level.
Narrator: Make Way is currently implementing the Intersectional Community Scorecard at three sites in Kenya—each of these sites presents different challenges and opportunities.
Sammy Obara: Kilifi is a coastal town that also has tourism facilities. It has one of the worst health indicators in Kenya. The community scorecard is very appropriate for them. Predominately, it is a Muslim community, and that also brings up dynamics around gender and SRHR issues, which are heavily controlled. So it's a powerful tool for discussion and trying to address needs and barriers, and barriers that have been there for a long time, historical barriers. Then two, we are in Makueni. Makueni is a semi-arid area with a high incidence of poverty, but also on the highway at the XX the way from the hinterland, going all the way to Uganda. So it brings up a lot of variables in terms of that highway, various communities—truck drivers, sex workers, communities withdifferent sexual orientations. So it's a very interesting geographic location. The third one that we are going to use the community scorecard is Kisumu. Kisumu is a lake region, a Lake Victoria region area with the highest prevalence of HIV and AIDS. But also we have a big LGBTQI community, and a lot of also young people and learning institutions, so there's a mix of learning in that center. So those are kind of the three groups or geographical sites we are using this scorecards, with different cultural backgrounds. So it's a very interesting learning scenarios.
Narrator: After undertaking the Community Scorecard process in the three sites in Kenya, the Make Way program team is already seeing positive results. For example, in Kilifi, youth now have regular access to SRH services and a good working relationship with the health facility staff. They also secured a nurse/counselor to attend to youth SRH needs at all hours of the day.
It can be daunting for those looking to implement more equitable SRH programs—especially when it comes to working with those in power. We asked Sammy what advice he would have to someone new to this process.
Sammy Obara: Of course, for a start, the entry process is always difficult, especially from the government. They look at the community scorecard as a mechanism of improving accountability, which is uncomfortable. So you must start by explaining the benefits of the community scorecard, that is one. And then two, you also explain the possible misinterpretation that will come out of the community scorecard from both the government and then from the various community members. And three, you try to let them understand the power of dialogue. Through dialogue, they can improve their own condition. So it's a process, it's a challenge, of course you will have suspicion by both groups, because you must know that the participation is understood differently. So it has been a process of sensitization.
Narrator: Sammy told us that a key to using this tool in different geographic settings is being willing to adapt.
Sammy Obara: Yes, the standard criteria remain, but you must keep on adapting. Adaptation here, I'll bring in the following areas, is at the coast, the religious element comes in very strong. And therefore, you must look at the simple things—the gender aspect of the community scorecard, the faith aspect, trying to bring in the traditional leaders who are respected, try to bring in the Muslim leaders who are respected as your champion as you mobilize. So mobilization angle must bring in gatekeepers who command respect. That may not apply in an area like Makweni, which is more or less the youth who take the leading role in mobilization because it is more or less democratic and open. And the same also applies in Kisumu. But again also in Kisumu, you must be cautious about the issue of the religious leaders, which is predominately Christian. So the adaptation keeps on varying, but without compromising the standards. The adaptation is the mobilization, and the setting of the scene before you start the community scorecard processes.
Narrator: We asked Sammy what other recommendations he has for those new to the process of using the intersectionality approach in FP and SRH programs.
Sammy Obara: I think for me the first thing I would say that you need to strategic partnership by those who have already implemented the intersectionality just beyond seeing it. The strategic partnership two is practically observing how it is being done, and the experiences it is generating. And three, is the do's and the don'ts of the intersectionality approach varies. And it varies at all times. For example, right now, in Kenya, you cannot mention the word LGBTQI because of the court ruling... the court has ruled that LGBTQI community has a right to association. Now previously, we were using this word, it was open in intersectionality, but right now, it can create an unsafe group. So sensitivity to the environment. What has worked today may not work tomorrow, so you keep on adapting and learning. So practically it's very important. And four, you must have very good safety guidelines in place. Those safety guidelines must ensure that you keep on adapting with the changing environment. So you must keep on contextualizing intersectionality to your situation and bringing your audience to understand intersectionality from their context, is very important as you move on. You must keep on learning and adapting and learning as you implement.
Narrator: Sammy also encouraged others to implement this approach with safety in mind, especially when working with marginalized, underserved, and often vulnerable communities.
Sammy Obara: The first thing is when you mobilize the group is the you do no harm principle. So the safety guideline helps you mobilize cautiously, and helps you engage cautiously, and helps you to start breaking those barriers sensitively, step by step. And then two, the safety guidelines also help you to keep on empowering the community on the need to remove barriers, but in a way that they're comfortable with, so it's a process. The most important thing is the rule of the thumb: Do no harm. And then two, the people you're mobilizing, especially those at the margins, those who through historical, structural issues, like widows, persons with disability, communities with different sexual orientations, they're already structurally being marginalized. So ensure as you're trying to bring them out of the margins that there is buy-in. Buy-in by educating the community about the bias-ness that creates prejudices and judgements that hurts and dehumanizes all of us. So you must keep on sensitizing the community of the value of humanity But along the way, you must also be [cautious] of the hardliners. So the hardliners, what you do is you create what we call safe spaces. You talk to various groups in their safe space, and at the end of the day you're going to get all this data, and you'll try to analyze that data for different groups. And when you're disseminating, when you call them, you let them know the harm they're doing. So you disseminate to various structures separately because of the sensitivity of the findings. And the harm it can create.
Narrator: In other words, not only is it important to implement the scorecard with separate groups in safe spaces, as needed—but it also may be necessary to communicate the scorecard’s findings separately as well.
Keeping these safety principles in mind, Sammy encouraged the SRH community to realize the power of the Community Scorecard, and of the intersectionality approach at large.
Sammy Obara: Through the community scorecard, you use data to make the invisible visible for the community leaders and the power holders and... those who make decisions. So you may use data of the community scorecard to make the invisible visible and they can get into the policy space. And in Kenya now, we have, in our health system, we have male, female, intersex, which is a good progress. Because initially, we were having male, female, and other. And now we have intersex as a distinct group.
Narrator: At the end of our conversation with Sammy, he shared some final thoughts about using an intersectional approach, and what has surprised him about using the Community Scorecard.
Sammy Obara: If you combine [the] Community Scorecard and intersectionality model, it's a good part for to challenge historical injustice within communities, within nations. Two, it's a good tool to check on our position of power and privileges, and how we are very blind to those spots and those privileges and power we enjoy. So it helps us to unpack and see the benefits of saying, “If I was in this person's situation, how will I respond?” It's a mirror that reflects on various groups when we engage them. And I hope it can be scaled up to improve our learning and policies that can really impact in the lives of people, dismantle class structure, dismantle bias-ness based on age, religion, race, ethnicity, sexual orientation and other classifications that by and large limit enjoyment of being a human being.
Narrator: As this season has shown us, no community is homogenous, and we must consider the different, often overlapping identities of individuals served by our FP and SRH programs. By looking at the effects of these multiple identities—for example, those relating to gender identity, sex, religion, ability, ethnicity, or social status—we can uncover power dynamics and systemic barriers that prevent many individuals from obtaining the sexual and reproductive health services they need and desire. And by using the intersectionality approach and the tools introduced by Make Way throughout this season, not only can we make our policies and programs more inclusive and accessible, but we can also begin to break down structures of power and privilege and ensure that we leave no one behind.
Season 5 of Inside the FP Story is produced by Knowledge SUCCESS and VSO. This episode was written by Sarah Harlan and edited and mixed by Elizabeth Tully. It was supported by an additional team, including Brittany Goetsch, Cariene Joosten, Polly Walker, Marjorie Mbule Tienke Vermeiden, and Caroline Wambui.
Special thanks to our guest, Samuel Obara.
To download episodes, please subscribe to Inside the FP Story on Apple Podcasts, Spotify, or Stitcher; and visit knowledgesuccess.org for additional links and materials.
The opinions in this podcast do not necessarily reflect the views of USAID or the United States Government.
If you have any questions or suggestions for future episodes, feel free to reach out to us at info@knowledgesuccess.org.
Thank you for listening.
Resources