Enablers of sexual and reproductive health and rights interventions in low- and middle-income countries. Insights from capacity development projects implemented in 13 countries in Africa and Asia

Figures & data

Table 1. Enablers of SRHR interventions in low- and middle-income countries: Phases of the international training programme in sexual and reproductive health and rights (SRHR).

Phase/setting	Activity	Duration
Phase 1/home countries	Participants received updated reference literature about SRHR’s international policies and guidelines.	2 months
Phase 2/Sweden	An advanced training in SRHR was conducted at Lund University using various pedagogical methods. Participants were guided by supervisors to plan and design change projects.	4 weeks
Phase 3/home countries	Participants implemented change projects in consultation with stakeholders.	6 months
Phase 4/Asia or Africa	All participants from the same cohort gathered to present their implementation progress, shared experiences and planned for sustainability at a results seminar.	1 week
Phase 5/home countries	Using feedback from phase 4, participants finalised their change projects, presented their final reports to key stakeholders and completed an evaluation questionnaire.	6 months

Figure 1. The ‘Inputs-Process-Outputs-Outcomes-Impact’ framework used in the evaluation of capacity development interventions implemented in 13 countries in Africa and Asia (N = 99).

Table 2. Enablers of SRHR interventions in low- and middle-income countries: Scales’ reliability test scores.

	Item-total correlation	Cronbach’s alpha if item deleted	Scale’s Cronbach’s alpha
Improved organisational effectiveness (6 items)			0.93
Organisation’s effectiveness in planning processes has improved	0.83	0.92
Organisation’s ability to address internal and/or external factors affecting a planned project has improved.	0.80	0.92
Organisation’s effectiveness in monitoring and evaluation of new projects has improved.	0.84	0.92
Organisation’s effectiveness regarding working routines has improved.	0.84	0.92
Organisation’s ability to increase the target group’s knowledge and demand for SRHR has improved.	0.79	0.92
Organisation’s attitudes towards the target group have changed for the better.	0.73	0.93
Improved team capacity (6 items)			0.97
ITP provided new knowledge on the subject matter	0.87	0.96
ITP improved my technical skills to plan and implement change	0.94	0.96
ITP provided skills to deal with the change processes within the organisational framework	0.91	0.96
ITP had an important impact on value issues that were important for the implementation of the change	0.85	0.97
ITP made me ‘think outside the box’ which became an important factor for the change implementation.	0.94	0.96
ITP gave access to a network of colleagues and other individuals of importance for the change implementation	0.92	0.96
Stakeholder involvement (6 items)			0.83
Oral presentation to Embassy of Sweden	0.58	0.81
Oral presentation to UN	0.68	0.81
Presentation of sustainability plan to own organisation	0.61	0.81
Presentation of sustainability plan to Embassy of Sweden	0.62	0.81
Presentation of sustainability plan to UN	0.58	0.82
Writing a report to ministry of health and education	0.52	0.82
Adopted new SRHR approaches (3 items)			0.79
Change project led to the development of new guidelines	0.58	0.76
Change project led to implementation of new policy in other organisations	0.52	0.77
Change project led to implementation of new guidelines in other organizations	0.62	0.76

Table 3. Enablers of SRHR interventions in low- and middle-income countries: Distribution of self-rated scores for the independent and dependent variables (N = 99).

	Median score (range)		Number of projects N (%)
Independent variables
Improved team capacity	27 (6–30)	> Median (Agree)	76 (76.8)
		≤Median (Disagree)	23 (23.2)
Adopted new SRHR approaches	4.6 (1–6)	≤Median (Yes)	41 (41.4)
		> Median (No)	56 (56.6)
		Missing	2 (2.0)
Stakeholder involvement	8 (1–12)	≤Median (Yes)	52 (52.5)
		> Median (No)	45 (45.5)
		Missing	2 (2.0)
Media engagement	3.1 (1–4)	≤Median (Yes)	50 (50.5)
		> Median (No)	49 (49.5)
Partner support	2.3 (2–4)	≤Median (Yes)	47(47.5)
		> Median (No)	43 (43.4
		Missing	9 (9.1)
Dependent variables
Organisational effectiveness	Mean 23.7 (SD = 3.9)	>Mean (Agree)	58 (58.6)
		≤ Mean (Disagree)	41 (41.4)
Increased awareness and demand for SRHR services	3.6 (3–4)	≤Median (Yes)	39 (39.4)
		> Median (No)	28 (28.3)
		Missing	32 (32.3)
Promoted sexuality education	3.6 (2.6–4)	≤Median (Yes)	39 (39.4)
		> Median (No)	28 (28.3)
		Missing	32 (32.3)
Increased access to SRHR services	3.6 (2.5–4)	≤Median (Yes)	38 (38.4)
		> Median (No)	29 (29.3)
		Missing	32 (32.3)

Table 4. Enablers of SRHR interventions in low- and middle-income countries: Bivariate logistic regression between independent and dependent variables (N = 99).

	Improved organisational effectiveness	Increased awareness of and demand for SRHR	Promoted sexuality education	Increased access to SRHR services
	OR 95% (CI)	OR 95% (CI)	OR 95% (CI)	OR 95% (CI)
Improved team capacity Ref (Disagree)	6.14 (2.15–17.52) ***	0.44 (0.12–1.57)	0.67 (0.19–2.33)	1.08 (0.31–3.84)
Adopted new SRH approaches Ref (No)	0.41 (0.18–0.94) *	1.55 (0.55–4.31)	2.69 (0.95–7.64)	0.61 (0.22–1.75)
Stakeholder involvement Ref (No)	0.54 (0.24–1.23)	0.91 (0.33–2.52)	0.77 (0.27–2.15)	1.85 (0.67–5.12)
Media engagement Ref (No)	2.64 (1.16–6.02) *	1.40 (0.49–3.99)	2.55 (0.84–7.70)	1.53 (0.54–4.37)
Partner support Ref (No)	3.68 (1.51–8.97) **	3.00 (1.05–8.55) *	1.96 (0.71–5.41)	3.41 (1.19–9.76) *

*p value ≤0.05, ** p value ≤0.01, ***p value ≤0.001.

OR : odds ratio.

Table 5. Enablers of SRHR interventions in low- and middle-income countries: Multivariate logistic regression between improved team capacity and improved organisational effectiveness adjusted for other covariates in four models (N = 99).

	Improved organisational effectiveness
	Model 1 AOR (95% CI)	Model 2 AOR (95% CI)	Model 3 AOR (95% CI)	Model 4 AOR (95% CI)
Improved team capacity Ref (Disagree)	5.97 (2.01–17.72) ***	6.11 (2.02–18.47) **	10.76 (3.02–38.36) ***	12.96 (3.35–50.19) ***
Adopted new SRH approaches Ref (No)	0.38 (0.16–0.93) *	0.36 (0.14–0.92) *	0.29 (0.10–0.79) *	0.26 (0.079–0.83) *
Stakeholder involvement Ref (No)		0.80 (0.31–2.06)	1.15 (0.42–3.18)	1.33 (0.40–4.40)
Media engagement Ref (No)			5.07 (1.69–15.16) **	5.28 (1.57–17.71) **
Partner support Ref (No)				4.42 (1.45–13.43) **

p value* ≤0.05, p value** ≤0.01, p value *** ≤0.001.

AOR : adjusted odds ratio.

Model 1: Adjusted for ‘adopted new SRHR approaches’.

Model 2: Adjusted for ‘adopted new SRHR approaches’ and ‘stakeholder involvement’.

Model 3: Adjusted for ‘adopted new SRHR approaches’, ‘stakeholder involvement’ and ‘media engagement’.

Model 4: Adjusted for ‘adopted new SRHR approaches’, ‘stakeholder involvement’, ‘home organization support‘ and ‘partner support’.

Table 6. Enablers of SRHR interventions in low- and middle-income countries: Multivariate logistic regression between improved team capacity and improve SRHR outcomes adjusted for other covariates in four models (N = 99).

	Increased awareness of and demand for SRHR services
	Model 1 AOR (95% CI)	Model 2 AOR (95% CI)	Model 3 AOR (95% CI)	Model 4 AOR (95% CI)
Improved team capacity Ref (Disagree)	0.43 (0.12–1.55)	0.45 (0.12–1.63)	0.47 (0.13–1.78)	0.39 (0.09–1.66)
Adopted new SRH approaches Ref (No)	1.49 (0.53–4.22)	1.69 (0.57–5.02)	1.66 (0.55–4.98)	2.31 (0.67–7.96)
Stakeholder involvement Ref (No)		0.69 (0.23–2.09)	0.69 (0.23–2.09)	0.62 (0.18–2.06)
Media engagement Ref (No)			1.15 (0.37–3.58)	0.96 (0.26–3.45)
Partner support Ref (No)				3.38 (1.08–10.51) *
	Increased access to SRHR services
Improved team capacity Ref (Disagree)	0.99 (0.27–3.58)	1.09 (0.30–3.98)	1.32 (0.35–5.08)	1.21 (0.31–4.82)
Adopted new SRH approaches Ref (No)	0.61 (022–1.75)	0.53 (0.18–1.63)	0.47 (0.15–1.51)	0.46 (0.13–1.68)
Stakeholder involvement Ref (No)		1.97 (0.67–5.80)	1.99 (0.67–5.93)	2.38 (0.71–8.03)
Media engagement Ref (No)			1.90 (0.60–5.98)	2.01 (0.53–7.65)
Partner support Ref (No)				3.82 (1.22–11.97) *

p value* ≤0.05,

AOR : adjusted odds ratio.

Model 1: Adjusted for ‘adopted new SRHR approaches’.

Model 2: Adjusted for ‘adopted new SRHR approaches’ and ‘stakeholder involvement’.

Model 3: Adjusted for ‘adopted new SRHR approaches’, ‘stakeholder involvement’ and ‘media engagement’.

Model 4: Adjusted for ‘adopted new SRHR approaches’, ‘stakeholder involvement’, ‘home organisation support‘ and ‘partner support’.