Transforming Access to Sexual and Reproductive Health: The Tombey Approach

Chinonso Kenneth (Lead Writer)

In 2021, Oluwafisayomi Olowu came across the Hacey Health Initiative call for sexual and reproductive health and rights (SRHR) champions to be trained as peer educators to disseminate SRHR knowledge to other young people. She had always been keen on empowering young people to be more knowledgeable about their sexual health and reproductive rights. As the National Public Relations Officer for the Nigerian Universities Nursing Students Association at the Ladoke Akintola University of Technology, Oyo State, she actively sought opportunities to volunteer for SRH-related initiatives.

“As an undergraduate, I was always volunteering and interested in issues relating to SDG 3, SRHR, and female genital mutilation (FGM). So, when I came across the Hacey project and saw that they were willing to train the champions to create better social media content on SRHR, I applied,” Oluwafisayomi said.

A 2022 report published by the African Women’s Development and Communication Network showed that 40% of all new HIV and sexually transmitted infections occur among 15–24-year-olds and just 2.9% of adolescents in Nigeria use any method of contraception. However, just 43% of young women and 34% of young men aged 15–24 have a thorough understanding of HIV and STIs.
These figures reveal that a higher percentage of young people in Nigeria are sexually active and awareness about sexual and reproductive health in Nigeria, particularly young people is lacking.

The Tombey Project

Isaiah Owolabi, co-founder of Hacey Health Initiative, stated that the lack of access for young people to sexual and reproductive health services prompted the establishment of the Hacey Health Initiative in Kwara State, in October 2007.
“We could see the high rate of teenage pregnancies and misconceptions regarding SRHR. We also saw the reality of young girls in many communities where maybe a young girl will get pregnant and would have to pull out of school while the young boy continues,” Owolabi said.

According to Owolabi, the initiative sought to support young girls in achieving their full potential. Thus, in 2016, Hacey Health Initiative launched the Tombey project to provide young people across Nigeria with accurate SRHR information and access to sexual and reproductive health services. The main goal of the project was to make it easier for young people, particularly young girls, to find accurate SRHR information and quality services.

“One unguarded moment for young people, especially when they don’t get it right in terms of their sexual and reproductive health, can actually cost them their lives. It doesn’t mean they will die immediately, but it can change the trajectory of what they could and might become,” Owolabi explained.

To achieve this goal, Tombey offers a comprehensive online course on SRHR, a sextionary to define SRH terminologies and highlights already existing youth-friendly SRH counselling centres across Nigeria where young people can access SRHR resources and counselling services.

The sextionary is an online dictionary that describes SRHR concepts and terms to help young people understand them. The Tombey sextionary, organised alphabetically from A to Z, offers an estimated 100 definitions for SRHR phrases and terminology, presented in an easy-to-understand format for young people.

“Our focus with Tombey is to put important SRHR information out there for example when young people suspect or realise that the person that they had sex with is HIV+, they should know that within 24 hours if they take a certain drug, it almost reduces their chances of contracting HIV to zero. We wanted young people to have all these information,” Owolabi explained.

Information is power

Tombey also developed a training manual and trains youth SRHR champions, who are then tasked with sharing SRHR knowledge to a minimum of 20 persons within their communities. This manual contains nine modules filled with infographics and comprehensive information on SRHR, including Gender and Social Norms, SRHR for Young People, Life Planning, STIs, HIV and Youth Vulnerability.
Since 2016, over 1000 champions have been trained physically by the Tombey project, and over 3000 young people have taken the Tombey SRHR online course. Owolabi stated that over 100,000 young people across Nigeria have been reached by the Tombey project, both directly and indirectly. According to Owolabi, anyone who takes the online receives a certificate, which allows the team to track the number of young people reached.

Oluwafisayomi, who is now a graduate and registered nurse, said that since her training with Tombey, in 2021, she has reached an estimated 2000 young people with SRHR information. According to her, she keeps track of the number of participants who attend the webinars and meetings she facilitates and uses any opportunity she has as a nurse to have frank discussions with young people about their sexual and reproductive health and rights.

The training is not limited to girls only. George Adjete, 24, a cohort of the Tombey 2021 SRHR champions in the Lagos State, has reached over 3,365 young people with SRHR knowledge as a result of his training through the three SRHR programmes he pioneered and other step-down trainings he has delivered.

“After the training from Tombey, I pioneered the boys’ chatter project to train boys and young men to be better versions of themselves in the spirit of gender equality and SRHR. I also initiated a community HIV testing service outreach in Lagos and Oyo states that reached over 115 people and a menstrual hygiene project where I shared the right information about menstruation health to over 250 young girls in Lagos, Osun and Ekiti states,” George said.

Historically, peer education has proven to be an effective approach for promoting SRHR knowledge among young people. Tombey pools together information and provides many ways for young people to ask questions and get factual answers from in-house and volunteer-trained counsellors, as well as teen guides. Young people can speak directly to a teen volunteer or make use of chat forums to share their thoughts freely.

Mapping for easy access

Young people frequently do not know where or how to access sexual and reproductive health services. The Tombey initiative mapped already existing SRH centres across six states (Lagos, Oyo, Ondo, Ogun, Ekiti and Osun) as well as youth-friendly centres in Lagos and Oyo State. The platform also has a search function to enable young people to identify nearby centres that may be state health facilities, non-governmental run SRHR youth centres, or privately owned SRH centres.

Florence Adegbamigbe, 25, who was a student at the University of Ibadan in 2020, explained that she was unaware that a youth friendly SRHR counselling centre was located in her school until the Tombey initiative came along and mapped it. “Before that (the Tombey project), I didn’t know there was a youth-friendly centre in school. That was my first-time hearing about it. There was a program held at the youth-friendly centre, and I attended and learnt a lot about SRHR,” Florence said.

“The Tombey project gave me more courage to be able to approach and talk to youths about their sexual health. Even just going to the youth-friendly centre, seeing youth and discussing with them helped me create more awareness,” Florence noted.

Navigating the hurdles

Despite the number of people who have been impacted positively with knowledge and services through the Tombey project, there are still challenges that have limited the project’s reach.

“The challenges relate to the reality of culture and tradition, which plays a role in how people think, such as when young people have access to SRHR information and services, it can help them be promiscuous.”

To mitigate these challenges, Owolabi said Tombey collaborates with gatekeepers within communities, including traditional and religious rulers. Tombey also leverages social media to target young people in the language they understand and is planning to leverage short SMS codes to disseminate SRHR information and services to young people, anywhere they are, in the near future. 
“A survey we did showed that young people under the Tombey project who had access to SRHR information and services had improved SRH behaviour,” Hacey’s Co-founder, Owolabi, noted.

According to Owolabi, the survey showed that the Tombey project reached 111,179 people directly, including out-of-school young people, in-school young people, people living with HIV/AIDS, sex workers, people with disabilities, orphans and vulnerable children.
The survey also revealed the dangers that these beneficiaries faced, which varied depending on preexisting conditions. Some who were not yet sexually active asked for help and skills to delay sexual initiation; others who had been sexually abused had concerns ranging from contracted STIs and the need for therapy and care. Others with multiple sexual partners and sex workers were more interested in learning about contraception and STI prevention.

It is critical that the government prioritises investments to ensure that young people have access to the necessary information to guide their development, particularly as it relates to sexual health. The Tombey project has reached a commendable number of young people with the information necessary to take control of their reproductive rights, but there is still room for state governments to expand on this project’s learnings to empower young people across the country.