Despite significant progress since its unification in 1990, Yemen remains one of the least developed countries in the Middle East, ranking lowest in the region in almost every poverty, health, and socioeconomic indicator. Because of early and frequent pregnancies, dispersed populations, and strict gender roles that discourage women from seeing male medical staff, infant and maternal mortality rates remain high. With a largely desert environment, Yemen's arable land and water resources are already stressed by the country's current population of nearly 25 million.
Pathfinder began working in Yemen in the early 1990s with three projects focusing on strengthening family planning education for midwives in health training institutions, supporting the Yemeni Family Care Association, and increasing community-based distribution of contraceptives. These projects, working in both rural and urban areas of the country, led the way in increasing acceptance of family planning among the Yemeni population. Pathfinder began to provide technical assistance to the USAID mission in Sana'a, which included support to address high levels of maternal and infant mortality in some of the most isolated and underserved parts of the country. This project was followed in 2006 by the Basic Health Services project, which enhanced and scaled-up the provision of family planning and reproductive, maternal, and neonatal healthcare to cover a larger geographic area of the country and reach a greater share of the population.
Today, Pathfinder is working to increase access to quality maternal health, reproductive health and family planning services in Yemen. To accomplish this Pathfinder is working closely with the local Yemen government to improve the clinical and managerial capacities of health management and health providers through workshops, trainings, tools and job aides.
Evidence for Decision-Making
A key aspect of Pathfinder's approach to systems' strengthening is collecting evidence that enables public, private, and community partners to make informed health-related decisions. In Yemen, examples of the kinds of evidence we collect range from the "number of people trained in maternal and newborn health through US government-supported programs" and the "number of workshops held to train selected religious leaders to implement training programs for other religious leaders" to the "total number of new midwives assisted to start private practices." Some illustrative data from Pathfinder's current work in Yemen suggests that:
- In the past three years, Pathfinder has provided more than two million Yemenis with evidence-based, culturally-sensitive information on family planning, maternal and newborn health, and reproductive health through community meetings and outreach
- In 2009, 358,667 children under 5 were vaccinated against polio through Pathfinder-supported projects
- In 2011, more than 91,500 community members attended outreach events
- In one year, 170 religious leaders were trained to incorporate development issues into their community outreach activities
Building Capacity, Strengthening Systems
Building the capacity of local stakeholders is critical to achieving long-lasting and sustainable change in Yemen. Many government institutions and NGOs are in need of better internal operations, more support for staff development, and skill-building for improved use of resources and data.
In order to address the lack of local capacity to implement sustainable projects, Pathfinder supports training activities, helps establish better policies and guidelines, and assists in assessing programs and implementing staff. Today, Pathfinder is collaborating with the Yemeni Ministry of Health and Population to assist with reviewing and updating policies and service guidelines. In the past few years, Pathfinder has helped to establish several NGOs working in reproductive and maternal health-including the National Alliance for Safe Motherhood, the Yemeni Public Health Association, and the Yemen Midwives. One recent example of Pathfinder's capacity-building work is the expansion of private and community-based midwifery services, in which midwives are demonstrating their increased capacity for quality work through a high acceptance by their communities, as a result of Pathfinder-supported training in clinical practices, business skills and provision of essential medical equipment and furniture.
This paper describes how ESD, with the Basic Health Services Project in Yemen and the Yemeni Women Union implemented the Safe Age of Marriage program as part of a national effort to reduce maternal and neonatal mortalities.
This paper show how ESD has supported the Basic Health Services Project in Yemen to assist midwives with setting up private practices in rural communities where fixed facilities and services do not exist, or are far away.
Muslim Religious Leaders as Partners in Fostering Positive Reproductive Health and Family Planning Behaviors in Yemen: A Best Practice
The paper shows how ESD partnered with the Basic Health Services Project in Yemen to engage Muslim religious leaders as champions of reproductive health and family planning, and partners in fostering social change and development.
This paper shows how Yemen's Al Saba'een Hospital became a model for postpartum care and family planning services with limited resources from the government and ESD.
The initial results of this pilot are promising. In one year, community educators reached 29,000 people, leading to an 18 percent jump in awareness in the benefits of delaying marriage. The program was instrumental in preventing 53 girl-child marriages.