One to one education and counselling session

Sexual & Reproductive Health for Marginalized Adolescents

Project profile: This project was implemented by Save the Children (SC) UK and Australia in partnership with ACCY, WOMEN and LYSCO with support of WCRD. SC aimed to improve knowledge and address risk behavior of young people on issues concerning HIV/AIDS/STIs transmission and prevention, in order to empower them to exercise more positive decisions over SRH and their bodies, especially young women.

The project took place in Phnom Penh and in 3 provinces: Kratie, Prey Veng and Takeo, working directly with young people as well as with those who interact with youth such as village chiefs, local authorities and Buddhist monks in pagodas. Other targeted groups included marginalized people such as HIV infected families with children, unmarried pregnant young women and Vietnamese youth living in Cambodia.

SC developed, gathered and adapted relevant IEC materials and organized SRH outreach activities including focus group discussions, support groups, role-playing and cultural events. Additionally, SC and partners mobilized, trained and supported volunteer peer educators (VPE) to promote life skills development among young people. Partners and youth outreach educators (YOE) also worked to improve the relations between youth and the local health services, and the establishement of a referral system by SC Australia helped to increase access to these services. Activities of educators helped to address stigma and discrimination in the target communities regarding SRH and HIV issues such as condom use.

Strategy: SC realized that there was a lack of SRH information and services for youth in Cambodia, especially in rural areas due to a significant gap between ASRH infrastructure in Phnom Penh and the rest of the country. Rural youth often migrates to work in urban centers and their lack of formal education often means risky professions such as working in karaoke bars / massage establishments, sex work, that can lead to drug, unwanted pregnancies, exploitation / violence, HIV/AIDS. Mother and children are more infected by AIDS than ever before. Poverty, social dislocation, high mobility, low levels of education and gender inequalities help to fuel the spread of the epidemic. Perception of risks is very low among youth and therefore the use of condoms is low. In fact, most areas hold traditional beliefs and norms that tend to stigmatize information about sex and SRH, and local health services seem to be unapproachable, both physically (remote) and psychologically (fear of judgement).

The project focus was to work directly with youth and key gatekeepers such as service providers, parents, Buddhist monks, developed IEC materials, organized outreach activities and events to increase access to ASRH information and services. SC identified target areas with potential large numbers of young migrants that would benefit the programme, and VPE and YOE provided youth with life skills, recording their name to be sure that every young person had been reached by the project. A referral system was established to include a list of all referral services in the target areas focusing on clinical services for SRH, and STI, VCCT home based care, trafficking, sexual exploitation and abuse. It was available for all partners and included working in collaboration with other institutions at the hospital level and with RHIYA partners. PE visited families infected by HIV/AIDS to teach them they should not be stigmatized and helped them to find the health and economic support they needed. PE also helped pregnant unmarried women to access necessary health care and become more accepted by the community / their families. After evaluation in 2004 PE approach was modified to have greater impact with target groups: youth were still used as educators (YOE) but not as peers. Education sessions were not initiated by persuading a group of diverse people to get together: youth set up their own support groups.

Outputs: 1) Increased political, community and family support for A/Y SRH intervention to create an enabling environment: Advocacy events were organized by the implementing agencies and undertaken at every opportunity: 80 campaign days were held in 2005 / 2006. SCA advocated at various forums across local, provincial, national, regional and international level; Numbers of activities were jointly organized with government officials: SCA worked with the NCHADS to coordinate activities at the national level and share the lessons learned with relevant organizations / government departments; A number of community gatekeepers were provided with specific ASRH knowledge: female gatekeepers were encouraged to attend activities (increase from 10.7% in 2004 to 67% in 2006 in trainings attendance); Continued meetings between YOE, parents and other community gatekeepers increased the community support and the collaboration with health center staffs; Number of activities included local leaders: Buddhist monks were trained and acted as mentors to other monks. 550 were involved in the project, providing advice and imparting knowledge on ASRH issues.

2) Enhanced awareness and knowledge of SRH issues among target group: Increased percentages of youth thinking information on contraception and on HIV/AIDS is easily available; Increased percentages of youth knowing on HIV/AIDS prevention methods and aware of STIs other than HIV/AIDS; Increased percentage of youth knowing ways of transmission of STIs; Increased composite indicators of SRH knowledge. (See numbers??)

3) Increased availability and access to quality SRH services to A/Y at risk in target areas: Quality of services: SCA developed in 2005 a guidebook and subsequently trained all SCA project staff, educators and partner NGO staff in standard referral protocols; Priority work was done with local health care providers to help increase the number of young people accessing health services (especially girls who are difficult to reach) and improve their quality. Numbers of youth were referred by age, sex and marital status (from outreach SDPs and among SDPs). At least once a month, partner NGO staffs and educators met with them, to discuss how local services could be more youth-friendly. SCA conducted trainings to all educators and supervisors on youth friendly services.

4) Enhanced technical, planning and managerial capacity for local provision of youth friendly SRH services: Number of staff and volunteers of implementing partners were trained to provide youth friendly SRH services by topic and by category of staff: SCA provided them with training on management, monitoring and report writing skills to strengthen their capacities, and also trained them on 7 SRH topics focusing on one topic at the time to provide accurate and confident advice essential for the success of the project and its sustainability. After a review of staff’s knowledge, the 7 topics were combined into 4 subject areas and the educators and their supervisors were given a one-day ToT session focusing on how to develop lessons plans and educate youth using participative approach. Each partner organization was visited on a monthly basis by SCA project staff and educators were observed on the field; Number of staff volunteers received refresher trainings (525 PE were provided with it); RHIYA project quarterly and annual reports were completed on time and approved by UNFPA RHIYA; Best practices notes / articles were disseminated and provided; Youth involvement was evident in the project design, implementation and evaluation: youth ownership was strongly encouraged; they solved problems alone when possible, prepared quarterly and annual reports… 48 community children were selected to participate in the production of IEC material.

Lessons learned: Revised role for YOE and VPE: Initially there was a PE program but SCA realized that once trained and provided with a t-shirt and a backpack, they had a tendency to be dictatorial and did not have the necessary knowledge to provide accurate information and answer varied questions. After the amendment of this model, the VPE were only expected to introduce young people to education activities, refer them to YOE if needed and help to distribute condoms. YOE were employees of partner NGOs and took over new responsibilities, becoming more diligent in their work. It was a very positive model and was recognized as Best Practice. There was little turn over among educators but if its was the case, their replacement learned “on the job” by being taken to the field to watch the educators in action.

It is important to work with well-established partners: NGOs: Their credibility in the community and the quality of their work is likely to be better and therefore more sustainable, since they have more knowledge of the target audience, are more aware of the current situation and are likely to have existing staff and volunteers that can undertake the role of YOE. Furthermore, at the end of the funding period, NGOs activities are more likely to be supported in the future; Local health authorities and other NGOs working in the same areas can help to negotiate with local health centers over the costs of treatment and services. Networking with them also benefits in the sense of a referral system; Monks’ participation increased the acceptance of SRH education in the community.

Importance of youth groups since it is an opportunity for youth to share knowledge, experience and feelings about SRH in a safe/youth friendly environment. Male and female can be more confident when discussing SRH issues together. Schedule and topics organized by members create ownership and collective understanding, therefore it is important to have strong network of active youth groups. It was found that a smaller group (5-8 people) creates better environment for discussing SRH issues and that groups should be done on the basis of age (12-15 and 16-20) and geographical area otherwise, if a youth has to travel far to reach a group, he tends to drop out. Overall, youth is increasingly happy to discuss sexuality and challenge the usual responses of discrimination and stigma.

Partner Profile: Save the Children works all over the world, fighting for children's rights. SC believes that children should have a voice, deserve to be treated fairly, not to be exploited. Children should have access to food, healthcare and education. They should just be able to be children. SC works all over the world to help make this happen. In Cambodia, Save the Children UK and Save the Children Australia worked in Kratie and Prey Veng provinces. Their work focused on supporting children to prevent HIV/AIDS and promoting reproductive health. Indeed, SRH knowledge not only provides ones’ health improvement but contributes to a better standard of living, greater employment opportunities, and improves self-esteem and decision making abilities of future generations.

Contact:

Save the Children Australia-Cambodia Program
Address: P.O. Box 52, Villa 51, Street 352, Boeung Keng Kang I Division, Chamcar Mon District, Phnom Penh, Cambodia.
Phone (885-23) 214. 334 / 363. 433 / 216. 222 / (012) 777.482.
Fax: (855-23)360.381.
Email: sca@sca-cambodia.org

Save the Children United Kingdom
Address: 1 St John’s Lane, London EC1M 4AR, UK
Tel: +44 20 7012 6400
Fax: +44 20 7716 2339
Website: http://www.savethechildren.org.uk
Email: enquiries@scfuk.org.uk