Terms of Reference Qualitative and Quantitative Research on the Barriers to Accessing Sexual Reproductive Health Services and Male Support at Plan International

Background: Plan International Nigeria is implementing the BMZ ÜH Project to Restore the Peaceful Coexistence and Social Cohesion of the Population Affected by the Conflict in the Lake Chad Basin. With the aim to promote social cohesion through the rehabilitation of social infrastructure and the integration of IDPs and refugees, the project will ensure that adolescent girls and boys, as well as young women and men in Yobe state of Nigeria have access to appropriate and timely SRHR services and structures and also, that Community mediation structures are in place in the project areas in Cameroon, Nigeria and Niger to prevent and deal with conflicts between members of the com-munity and to promote non-violent and peaceful coexistence of the various different groups living there.

As of 2019, 7.1 million people (1.4 million women, 2.3 million girls and 1.9 million boys) need humanitarian assistance in north-east Nigeria. While there has been a decline in the number of people who need life-saving humanitarian assistance, there has been an increase in people who require longer-term development support, especially in Yobe where the situation has somewhat stabilized.

The health system has been majorly affected by the conflict with health workers, especially those not indigenous to Yobe, having fled to other states. Indigenous workers are generally reported to have temporarily abandoned their work places during spikes of insecurity with most returning when the situation improves. Moreover, according to security updates received by Plan, health facilities have been directly attacked, with insurgents taking away drugs, hospital equipment, ambulances and other vehicles. In addition, some hospitals have had to be closed for some time until the local situation normalized. It has been observed that movement for health workers and patients to access health facilities has been a major challenge due to curfews imposed by the security services (the Joint Task Force, JTF), which have contributed to a challenging environment for the functioning of, and access to, health services. Essential, often life-saving, medical services for GBV survivors are not available in many affected areas. Where health facilities do exist, they often lack the necessary equipment, drugs, and trained personnel to provide timely adequate treatment. In a Needs Assessment conducted in September 2018 by REACH in accessible areas of Yobe state, 72% of the non-displaced households, 69% IDPs and 74% returnees need health support. A recent rapid assessment conducted by Plan International Nigeria shows that all 10 Primary Health Cares (PHCs) in the targeted wards are neither adolescent nor disability friendly. There are no ramps and any of the 10 PHC meets the minimum standards for gender responsiveness and adolescent friendly centers, with no staff currently trained, lack of equipment, adolescent corners and inclusion of adolescents and youth in health facility and community decision making platforms and processes.

A recent 2019 rapid gender analysis conducted by FAO in three North East states of Nigeria (including Yobe state) shows that the conflict has had significant impact on women and girls due to a shift in social and gender roles without a change in the patriarchal norms resulting in increased level of burden and vulnerability for women and young girls. There is an increasingly large number of female-headed households, with women taking part in new types of economic activities, decision making and provider roles while still limited by social norms that restrict their status, access and participation. The assessment showed the trend that only 7% of women from Yobe states participate in decisions around their health care and 5.9% participate in household decisions.