© Côte d'Ivoire

Ivory Coast

78.2%

of women between the ages of 15 and 49 do not use a modern method of contraception

3

women a day are diagnosed with cervical cancer

249,000

abortions are performed every year within a very restrictive legal framework

The need for humanitarian action in Ivory Coast

Women’s health: humanitarian emergency in Côte d’Ivoire, one of the highest rates of maternal mortality in West Africa

Côte d’Ivoire records a maternal mortality rate of 614 deaths for 100,000 , of which 15% are due to complications following unsafe abortions. In other words, between one and two women die in childbirth in the country every day.

There are still many barriers to accessing good sexual and reproductive healthcare, in particular the absence of a legislative framework for SRH, the lack of funding for contraceptive products and disruptions to supplies.

Low levels of contraception and early pregnancies: the need for medical assistance in Côte d’Ivoire

Just under one in two young people (45%) don’t use contraception the first time they have sex. More generally, only 30% of young people (aged 10-24) use modern methods of contraception. Every year significant numbers of pregnancies are recorded in primary and secondary school pupils, leading to high levels of unsafe abortions (75%, according to a study carried out in schools in 2018).

The law remains very restrictive on abortion

Yet despite Côte d’Ivoire having signed and ratified the Maputo Protocol, the law remains very restrictive on abortion (since 2019, the Penal Code only permits it in cases of rape). Healthcare staff are not trained in the management of unwanted pregnancies which increases the likelihood of people seeking unsafe abortions.

Precancerous cervical lesions too often overlooked

“Around 1,000 new cases of cervical cancer are recorded every year in Côte d’Ivoire, with a mortality rate of 65% ” (Médecins du Monde exploratory mission, 2017). Médecins du Monde’s 2017 exploratory mission highlighted a number of inadequacies: lack of training for healthcare staff, inadequate and or inappropriate awareness-raising and poor access to screening and treatment.

HIV, hepatitis and tuberculosis: high prevalence of infectious diseases and medical assistance which should be based on awareness-raising and access to care

Médecins du Monde conducted a study in Abidjan in 2014 among 450 regular users of cocaine, heroin and crack cocaine. The study showed that people who use drugs are vulnerable and at risk of infectious disease due to their unsafe sexual behaviour, drug use and extremely precarious living conditions.

In 2014 the rate of HIV among drug users was estimated to be 9.8% in Abidjan. Today the figure is around 3.4% (study for the national AIDS programme conducted by CECAF in 2019). There is a particular problem with STIs among people who use drugs, especially syphilis which has a prevalence of 9.3%. Similarly, levels of tuberculosis in this group are higher than in the general population (according to the CECAF study, 2.9% contracted it in 2019). This often leads to cases of HIV/tuberculosis co-infection. In addition, 12.1% of people who use drugs are carriers of the hepatitis B virus.

 

L'aide humanitaire apportée par Médecins du Monde en Côte d'Ivoire se traduit notamment par du soin proposé aux femmes et enfants qui n'ont pas ou peu accès à la santé © Sébastien Duijndam
L'aide humanitaire apportée par Médecins du Monde en Côte d'Ivoire se traduit notamment par du soin proposé aux femmes et enfants qui n'ont pas ou peu accès à la santé © Sébastien Duijndam

Our humanitarian assistance in Ivory Coast

The study carried out by Médecins du Monde in 2016 on the sociocultural determinants of unwanted pregnancy revealed that the sexual and reproductive health services available for young people are not tailored to their needs. Data from a study conducted in April 2019 show that only 30% of girls (10-24 years) who are sexually active use a ‘modern’ method of contraception, of whom 81% were using male condoms. In addition, 10.3% of girls interviewed for another survey had been pregnant at least once and 36.4% of pregnancies were terminated through abortion (60% of these are unsafe abortions).

Médecins du Monde has supported the public healthcare system

Since 2017, Médecins du Monde has supported the public healthcare system through a project which uses a rights-based approach and aims to improve prevention and management of unwanted pregnancies among young people in the Nawa region (in the west of the country).

IN 2020

we reached out to young people and, through our humanitarian work in Côte d’Ivoire we:

  • provided support for 17 mobile consultation sessions
  • made 510 home visits to vulnerable young people to provide psychosocial support
  • broadcast 5,460 radio spots to raise awareness about SRHR
  • reached 2,501 young people (1,258 female and 1,243 male) with awareness-raising about their SRH rights
  • monitored 81 pregnancies in young people

 

In an effort to find solutions to the issue of access to family planning services for women and girls, Médecins du Monde is supporting advocacy activities at the national level and is working with local and international actors to secure funding for and distribution of family planning supplies. As a pillar of our humanitarian work in Côte d’Ivoire, this advocacy work highlights the alarming health problems in the country.

 

 

Pregnant women in the waiting room of a health centre run by Doctors of the World. © Sébastien Duijndam
Pregnant women in the waiting room of a health centre run by Doctors of the World. © Sébastien Duijndam

Humanitarian mission in Côte d'Ivoire: key aspects of our health plan

Combining awareness-raising and access to care, our medical assistance in Côte d’Ivoire focuses on a number of health issues.

 

Covid-19: implementing effective measures

In response to the pandemic Médecins du Monde ran awareness-raising sessions on protective measures aimed at school pupils and households. The project stakeholders were provided with personal protective equipment and activities were carried out, while respecting protective measures and in accordance with WHO recommendations and Ivorian government guidelines.

As part of this, Médecins du Monde supported the national pandemic response through specific interventions targeted at people who use drugs in Abidjan. We delivered educational and prevention activities, distributed protective equipment at 58 consumption sites, provided food support to 6,220 people who use drugs and supported 22 healthcare facilities with Covid prevention supplies and equipment.

 

 

Treatment of precancerous cervical lesions: a humanitarian emergency in Côte d’Ivoire

Since 2020, Médecins du Monde has been working on a new project which aims to prevent, screen and treat precancerous cervical lesions in Abidjan. The Covid-19 epidemic delayed the start of the project which was eventually initiated at the end of the year and delivery will continue in 2021. Four innovative approaches will be trialled: implementing an organised screening strategy, self-testing as an alternative to testing by healthcare staff, PCR testing for HPVinfo-icon instead of VIA testing, and treating lesions by thermocoagulation as an alternative to cryotherapy.

In 2020

we:

  • launched a study entitled “Socio-anthropological research into partnership working by NGOs to implement humanitarian healthcare interventions at local and national level” in collaboration with LASDEL (social science research laboratory)
  • conducted a needs assessment of health centres in Abobo Ouest (Abidjan) to identify partner health centres for the project
  • organised a workshop to share experiences with the teams in Burkina Faso to determine Médecins du Monde’s operational intervention strategy in Côte d’Ivoire
  • established partnerships with stakeholders in the sphere, in particular JHPIEGO and the PNLCa (National Cancer Programme)

Supporting people who use drugs: Médecins du Monde’s commitment at the heart of our humanitarian mission in Ivory Coast

Since January 2015, Médecins du Monde and its local humanitarian organisation partners have been running prevention and harm reduction activities for people who use drugs in Abidjan, with the aim of improving the way they are treated by the healthcare system.

Care and access to care is thus an issue that lies at the heart of our humanitarian mission in Côte d’Ivoire.

Médecins du Monde is working to build these individuals’ capacity to act in order to develop appropriate responses and combat the stigmatisation, exclusion and criminalisation which represent barriers to accessing care.

The second phase of this project, launched in 2018, led to the opening in August 2019 of an Addiction Treatment and Counselling Centre (CASA) which provides holistic treatment and support for people who use drugs. The CASA currently offers a package of different services, including facilities for washing and laundry, places to rest, information and awareness-raising, distribution of harm reduction tools, screening and testing, medical consultations, welfare support, psychological treatment and community activities, alongside outreach work (HIV testing, primary healthcare and referrals).

Phase 3, which will be launched in 2021, aims to consolidate existing provision and replicate specially tailored integrated care services accessible for vulnerable people who use drugs in Grand Abidjan, Yamoussoukro, Bouaké and San-Pédro.

 

In figures: our humanitarian mission in Côte d’Ivoire in 2020

In 2020

Through our humanitarian mission in Côte d’Ivoire we delivered a range of projects seeking to address the health issues of particular concern in Côte d’Ivoire, we:

  • reached 11,332 people who use drugs through peer educators
  • provided consultations for 7,760 people who use drugs, including 774 women
  • distributed 42,740 condoms and conducted 8,003 HIV tests
  • trained 153 medical and community workers
  • supported 39 women who use drugs during their pregnancies and through to giving birth
  • supported 43 people who use drugs who had tested positive for HIV and been admitted to care and treatment services
  • monitored 79 people who use drugs who had contracted tuberculosis

 

 

our institutional support

Initiative 5%, financée par le ministère français des Affaires étrangères soutient Médecins du Monde
Le Fonds mondial de lutte contre le sida, la tuberculose et le paludisme soutient Médecins du Monde
History
2011
4-month emergency intervention in Abidjan following the post-election crisis.
2011
Project providing support in obstetric emergencies in the south-west of the country.
2012
Partnership for transition – support for targeted free care in the south-west of the country.
2014
Study among people who use drugs in Abidjan.
2014
Project to strengthen the Ivorian healthcare system.
2014
Preparation of a response to the Ebola epidemic in the south-west of the country.
2015
Opening of a programme for people who use drugs in Abidjan.
2016
Study of the socio-cultural determinants of unwanted pregnancy among young people.
2017
Community study of the prevalence of tuberculosis and associated factors among people who use drugs in Abidjan.
2017
Project for the prevention and treatment of unwanted pregnancy among young people in schools in Soubré.
2019
Second phase of the harm reduction programme for people who use drugs in Abidjan and opening of the Addiction Treatment and Counselling (CASA)
2020
New project which aims to prevent, screen and treat precancerous cervical lesions in Abidjan

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