Peer education session for girls only

RHAC Adolescent Reproductive Health Project

Project profile: Beginning in January 2004 with the financial and technical support from EC/UNFPA, RHAC designed the Adolescent Reproductive Health Project to provide health information, clinical service and counseling to youth aged 10-24. The project served around 97,784 Cambodians and employed 16 staff. Its activities were implemented in 79 villages and 16 schools in Phnom Penh, Takeo and Kampong Cham.

RHAC collaborated closely with gatekeepers including local authorities (from provincial or municipal governors to village chiefs), relevant Ministries such as the MoH and the MoEYS and provincial health departments and in order to strengthen gatekeepers’ support for ASRH interventions at local, provincial and national levels. The project provided on-going youth-friendly services (YFS) for young people, offered at RHAC clinics. The staff from two government health centers was trained on YFS provision to increase accessibility for young people in rural areas. Youth centers in RHAC clinics housed a counseling room and a library where young people could gathered to read, socialize, and wait for clinical services.

Outside the clinics, RHAC’s peer educators (PE) worked with both in-school and out-of school youths who were informed on topics such as HIV/AIDS, STIs, birth spacing, emergency contraception, safe sex, gender issues, menstruation, body changes, drug use and life skills. Teachers-counselors were also involved in the support of peer educators. Awareness was promoted through discussion, one to one talks and traditional dramas. Other project activities included quiz shows on SRH issues, and village edutainment.

Strategy: RHAC identified that people aged 10-24 are deeply vulnerable to a number of SRH issues, especially to HIV/AIDS. The opening of Cambodia to world culture (Media/mass culture) and peer pressure shape youths’ behavior and their way of life. Illicit drug use is increasing and despite the government’s efforts to improve ASRH situation, progresses still need to be done. Indeed, school curricula do not sufficiently equip youth to deal with SRH problems mostly because MoH gave more attention to maternal and child health in general and in HIV/AIDS in particular, than to adolescent health needs. This lack of information and knowledge among youth is also due to gatekeepers’ interdiction / restriction on SRH education. To resume, RHAC found out a need to increase political support from policy makers and local authorities, and was therefore committed to address these problems through the principle of community participation, the utilization of the community structures and resources, building capacity and transferring knowledge/practice to the community.

RHAC designed and developed a three-pronged strategy focusing on promoting awareness of ASRH through peer education approach: 2 peer educators (PE) per village and per class were thus recruited (one male, one female), trained and retrained on ASRH topics to provide related education sessions to young people. The second ideal was to develop and expand YFS such as clinical services with a separate space for young people to access SRH services, non–clinic services and 2 youth-friendly government health centers. These services were free for youth unable to pay. New activities targeting out of school youth focused on vocational training. Finally, RHAC’s third focus was to create an enabling environment through working with various stakeholders, paying home visits to parents and developing mechanisms to enable the community support of the project (various meetings, home visits to parents, public events). RHAC also focused on involving young people as PE.

Outputs: 1) Increased political, community and family support for ASRH intervention creates an enabling environment: For each project location, RHAC organized: Orientation Meetings for gatekeepers before the project implementation and Annual Review Meetings which attended by 318 key stakeholders including governors, ministries’ officials, local authorities, parents and youth. RHAC also organized Annual youth gatherings which were advisory groups in which PE, teachers-counselors and local authorities could discuss on the project’s improvement. Moreover, various public events (concerts, quiz shows, educational dramas) were facilitated by RHAC and attended by 15,037 youths. The project staff also participated in the Provincial Technical Working Group for health and other local meetings to integrate ASRH into the discussion among stakeholders. Additionally, RHAC involved teachers in the project and trained them to become “teachers-counselors”. They were then able to conduct SRH education sessions for school students and contribute to ASRH improvement.

2) Enhancing awareness and knowledge of SRH issues among target A/Y: RHAC adopted a strategy based on 2 pillars: First it focused on improving PE training and building staff capacity: PE training curriculums and IEC materials were regularly updated and shared with other organizations and relevant national/provincial health departments. The project staffs were trained on community advocacy materials, ASRH, behavior change, communication, participation, project planning & monitoring and how to work with target groups. Moreover, life skills / SRH information were organized into 5 key topics to facilitate the understanding of messages among youth. Secondly, RHAC focused on National youth friendly SRH services and therefore contributed to the development of the National Standard Guidelines for ARSH services initiating nation-wide trainings and YFS delivery at government health centers and referral hospitals. There was thus a positive correlation between the programme exposure and the SRH knowledge gained: 98% of the target groups now know at least one way of HIV transmission and 94% know at least one way of contraceptive method.

3) Increase availability and access to quality SRH for vulnerable A/Y in target areas: A total of 81,456 youth aged 10-24 received clinical services including Reproductive Tract infections (RTI) treatment, VCCT and contraceptives services. A total of 1168 youth received counseling from RHAC counselors at youth centers which provided not only clinical information, advice / counseling but also information that was not available in group discussions (love, school, family problems...). RHAC especially focused on the integration of YFS into the 2 government health centers: the project built youth libraries with ASRH annex to each of the health centers and facilitated their work with PE for referral. The health center staff received an initial training on YFS delivery to build its capacity /increase its interest in ASRH and was provided with technical coaching to improve its clinical / communication skills with youth. YFS utilization increased of 49% from 2005 to 2006.

4) Enhanced technical, planning and managerial capacity of local provision of YFS: To contribute to this, RHAC’s management and senior staff provided technical assistance to the project staff, thus enabling them to provide support for other stakeholders and improving their own capacity. UNFPA also provided capacity building to the project staff through training them on fund raising and proposal development. 18 projects staffs were trained on relevant SRH topics. Other training topics included project management, effective presentation skills, reports writing, problems solving, fundamental advocacy training …etc. RHAC recruited and trained 824 PE (462 in school and 362 out of school) focusing on STIs, HIV/AIDS, adolescent growing up, nutrition, pregnancy, drug use, contraception, ASRH rights, life skills. PE were thus able to train in turn young people and help them to discuss these issues with their parents. In addition, the project also trained and provided refresher training to government health center staff, CARE and other NGOs’ staff on the provision of YFS.

Lessons learned: Project implementation: From the experience, achievements and internal evaluation, it is indicated that RHAC’s three-pronged strategy was effective and acceptable to the community and youth. RHAC covered many aspects the target group needs, from overall health concern to rights and sexual abuse, to gender and social skills. Involving community members and utilizing the existing community infrastructure (PE network, teacher-counselors, youth centers...) was seen as an effective approach for sustainability of the project. Therefore in the future, instead of establishing youth advisory groups, RHAC will try work with the existing community structure since it s not worth developing parallel structures. However, RHAC thinks that a lot of advocacy work still needs to be done at the national and provincial level to gain more commitment from the policy makers and senior government officials.

SRH knowledge: Promoting ASRH is a continuous task: MoE made initial efforts in integrating life skills into the general education curriculum but the government relies mostly on the civil society to work with youth on SRH and this may slow down the progresses undertaken by RHAC. There is thus a continuous support needed from NGOs. However schools principals / teachers-counselors will continue SRH education activities in schools for sustainable progress on these issues. Throughout the project, youth learned how to access SRH information, counseling and services.According to RHAC’s evaluation report, there is increase in ASRH knowledge and behavior among young people: about 92% of target group reported utilizing condoms when having sex with sex workers.

ASRH services: Hundreds of peers, stakeholders and health center staff will remain in the community and this is a valuable asset for sustainability. However, the slow progress of the service utilization at government health centers revealed that success of these facilities not only depends on technical assistance but on the overall management of the health center as well. Leadership, ownership and commitment of the health center chefs are very important for an increase access to YFS. The final assessments revealed low numbers of out-school youth attending activities in youth centers, mainly because these youth centers are often part of the clinics or health centers. RHAC suggests adding new activities to encourage them to participate.

Peer educators/volunteers were the most driving force behind the increase in knowledge and change to positive behavior among young people and they are expected to continue doing so. However, it was noticed that the main beneficiaries of the programme were not the target group but the peer educators since they received the majority of the inputs through intensive training, communication and on-going staff support. Nonetheless, approximately 27,800 young Cambodian received benefit of exposure to the peer education activities.

Partner Profile: The Reproductive Health Association of Cambodia was established in 1996, as a local non-governmental organization run by local staff. A few months after its inception, RHAC adopted a constitution and elected a president and national council members, with the support of its volunteers. In November of 1996, RHAC was admitted as the Cambodian member of the International Planned Parenthood Federation (IPPF). RHAC's mission is to meet the needs of Cambodian people and try to assist them in improving the quality of their lives through the provision of model services, IEC and training in reproductive health.

Contact: Reproductive Health Association of Cambodia #6, Street 150, Sangkat Veal Vong, Khan 7 Makara Phnom Penh Cambodia Tel: +855 23 885 135 Fax: +855 23 885 095