Takamol Project

The Takamol strategy employed a two-pronged approach of health system strengthening (179 clinics and 21 hospitals) and community capacity building to address the full breadth of the RH service delivery value chain, from supplier to user. These activities were designed to reinforce each other, leveraging the strengths of the existing health system and assets of communities to generate improved RH outcomes. Communication-related highlights of the strategy include:

1. Provider strengthening activities focused on building providers' and team members' knowledge and practice of core RH areas. Across intervention sites, common training needs included: core competencies; counselling skills; topics specific to maternal and child health (MCH), family planning (FP), and RH; team-building for integrated service delivery; use of the Egyptian Maternal Mortality Surveillance System; management; and clinic–hospital referral systems. Takamol’s training activities also included an on-the-job training programme, which combined classroom teaching of best practices with practicum-like observed practice to maximise providers' understanding and effective application of the concepts learned in the classroom.
2. Community capacity building activities drew on the socio-ecological model for behaviour change.
   • At the individual level, Takamol offered integrated health and literacy classes to educate women about the basics of RH while they simultaneously learned to read and write.
   • At the social level, Takamol trained volunteer outreach workers from the community in child and adolescent health, lifecycle-phase-appropriate topics such as FP and pregnancy danger signs, and topics related to gender, such as early marriage and gender-based violence. Outreach workers conducted home visits to married women to provide one-on-one support, and couples' communication courses were designed to aid in creating supportive home environments in which spouses enabled women to access care.
   • To influence social factors outside the home, Takamol identified Community Development Associations (CDA) to engage community leaders in support of the project. Takamol identified religious leaders, literacy facilitators, and agricultural extension workers to receive community leader training and serve as community mobilisers. Community leaders educated the community, encouraging men and women to identify and address social barriers to care, thereby hopefully increasing demand for services. Community discussion forums similarly created space for active community-wide debate on social topics relevant to RH.
   • Takamol conducted civic and corporate engagement activities in its structural-level work. Democracy seminars educated women on the basics of democracy - from voting to community organising - and Takamol helped women register with the government, issuing identification cards that proved necessary for voting and to participate in government assistance programmes. In addition, to ensure that economic status was not a barrier to accessing services, Takamol implemented a corporate social responsibility (CSR) programme that encouraged public-private partnerships.

Reproductive Health, Children, Women.

According to organisers, economically poor women in Egypt are 2.5 times more likely to have a child die before the age of five than wealthy women. 57.4% of rural women do not regularly access maternity services during pregnancy, and 87% of all under-five child deaths in Egypt occur during the first year - and often within the first month - of life.

Takamol, which means "integration" in Arabic, was designed to build upon the advances of the Egyptian government's Health Sector Reform Program of the 1990s.