Addressing mental health and sexual reproductive needs in Guinee: a modern design to break through health-systems and sociocultural barriers.

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Where no psychiatrists are needed: building agency of women to address SRHR and Mental Health problems in Guinee
In Guinea, the quality of maternal and child health is among the lowest in the world. Access to maternal and newborn health care is limited - more than 20% of women do not receive any form of antenatal care and only 22% of women give birth in a health centre. The Guinean health system lacks infrastructure and skilled health workers, especially in rural areas. The 2014 Ebola outbreak has hindered the development of the already weak health system before the epidemy. The high rate of teenage pregnancy, combined with the widespread practice of female genital mutilation (FGM), also contributes to complications related to infant mortality and maternal mortality.

Another challenge that has an impact on SRH of women and girls in Guinea is risky sexual behaviour; prostitution, especially among young people, is widespread and increases the risk of contracting STIs, including HIV / AIDS. Gender-based violence is highly prevalent and Family Planning (FP) adherence is low due to different causes such as pro-natalist culture, religious beliefs, lack of health staff, rumours about the side-effects of contraceptive methods, low decision-making power of the woman in general, the many taboos around sexuality etc.

Proposed intervention
The proposal as prepared by Fraternité Médicale Guinée (FMG), a local organization based in Guinea and Culture for Change (C4C). The overall idea is to create more synergy between approaches and expertise of different actors and partners in the search for solutions to the main challenges related to Sexual and Reproductive Health in Guinea. The goal is to contribute to better reproductive and mental health for women and girls through improved access to services among youth and other vulnerable people and a behavioural change among the population at large. The different obstacles to SRHR and their underlying causes will be addressed through the following major axes.
• Objective 1: Reinforce the capacity and involve authorities and key people in promoting SRHR and preventing SGBV
• Objective 2: Improve the access to SRH services among youth and marginalized groups in order to ensure that people can make informed choices about sexual behaviour
• Objective 3; Sensitization of the population at large on SRHR and SGBV through theatre, an effective and evidence based method for transforming people's behaviour, including the most remote and poor populations.
By realizing the potential of their own resources women can address mental health, social and sexual-reproductive health needs in Guinea. During the implementation period the active partnerships will be established with other actors and stakeholders working in the same area in order to seek complementarity that should lead to the achievement of the expected results.

Materials, intervention and methods The design is based on latest insights in realist research, complexity theory and implementation theory. As such it aims to show how sensitive issues can be effectively addressed in a complex setting, synergizing the potentialities, approaches and expertise of different actors and partners. The method leads to specific actions that
 Select and ‘dynamize’ agents of change in communities, who will work through different networks and groups according to needs and priorities identified in a repetitious process;
 Use social actions including theatre and public debates as effective methods of transforming people's behaviour through instilled reflection on contexts that shape mental health, SRHR and SGBV issues.
 Organise cross referral and collaboration between a variety of services, and strengthen accountability and sustainability of service delivery.
Innovative aspects: We do not work with preconceived ideas for solutions, western-based blueprints or donor-specific protocols. We organize exchange between local and international partners to link local effectiveness to international knowledge. Application of new insights in implementation theory and complexity management leads to a dynamic process of change, rather than traditional project implementation.