Community Actions for Improved Youth Sexual Reproductive Health

Project Profile. Aamaa Milan Kendra (AMK) implemented the RHIYA from September 2003 to improve the SRH practices / behaviour and increase the utilization of SRH services by adolescent and youth (A/Y) of 15 VDC (Village Development Committees) & 1 municipality in 3 districts in Nepal: Morang, Rupandehi and Syangja.
The project targeted A/Y aged of 10-24 years particularly illiterate, out-of-school and dropouts, to make them aware on SRH issues including HIV/AIDS, human trafficking, gender based violence (GBV) and life skills by enhancing their SRH knowledge. School students of 5-10 classes were also direct beneficiaries of the program. Secondary beneficiaries of the project were peers of A/Y, youth club members, parents, school teachers, health service providers, social workers, community leaders and other community people.
The cooperation, collaboration, mutual support from the GoN and other networking organizations and political leaders and high motivation of youth mobilisers, peer educators, A/Y involvement of local clubs, active participation of parents, adult members of the community and local health service providers were the key factors in achieving the project aims. AMK established YICs, and upgraded GoN health facilities. Some of the more specific projects included a youth camp and a national adolescent girl’s congress.

Strategy. AMK’s strategy was based on creating a supportive environment, involving and strengthening local clubs, mobilizing the community people / local level volunteers, introducing peer education program, establishing youth information centers (YIC) and upgrading the local level GoN health facilities with youth friendly service (YFS) and capacity building of project staff through training / workshop at various levels.
The project constantly focused on sustainability while designing the program and throughout its operation. There was a consensus on wider partnership building to create ownership, optimum utilization of limited resources and hence sustainability. AMK raised the support of political leaders, established a strong network with community-based organizations / local youth clubs and mobilized parents, community, teachers, social workers, health service providers and other stakeholders by organizing them into support groups. They were provided with ASRH knowledge / skills through workshops & involvement in the project. Each support group developed its action plan with A/Y under the supervision of district managers who provided assistance when needed. Central level staff was responsible for overall operation.
As part of the strategy, the project’s work plan and logical framework were reviewed to make it similar to the regional level RHIYA partners. Certain activities were removed: E.g. basic literacy class for adolescent girls, because it was sometimes difficult to train 25 illiterate girls from one venue and difficult for them also to participate in the meeting of peer group and literacy at the same time. Similarly, after the review of the project some activities were included depending on needs: E.g. Most of the GoN health centers were less equipped to provide YFS so AMK provided furniture and equipments.

Outputs.
1) To increase political, community & family support for ASRH interventions and actions to prevent HIV/AIDS: Collaboration, joint activities, support & cohesiveness among staff, stakeholders & A/Y was realized: At district / VDC level, coordination committees & 15 support groups were formed and 288 coordination meetings were held to plan, implement, review and receive support. A total of 4355 community gatekeepers including 325 support group members gained knowledge on ASRH, STIs, HIV / AIDS and GBV to sensitize in turn community people; as a result, hesitations to discuss on SRH decreased and demand for such program increased beyond the targeted population & areas. Networking with concerned ministries/departments, I/NGOs, UN agencies and political leaders from grassroots to central & international level was strengthened through meetings, trainings, seminars, workshops and various events. A total of 97 advocacy events were held and involved stakeholders: this created ownership & supportive environment. Also, more than 200 SRH activities were attended by staff and A/Y outside the RHIYA programme.

2) To enhance knowledge & awareness of A/Y on SRH, life skill issues & HIV/AIDS: Various ASRH related advocacy and IEC materials produced by AMK, GoN, NGOs, UN & RHIYA partners organizations were distributed to VDC support group members, PE, youth club members, partners & concerned I/NGOs to use for and by A/Y. These included more than 16,000 copies of 47 types of IEC materials such as newletter, brochures, ASRH handbooks, GBV flipchart, YFSDP/YIC guidelines, teachers training manual, HIV/AIDS flex chart, etc... Also, AMK produced promotional materials (caps, T-shirts..) & 1 documentary film. In total 23 types of programs & 226 activities on ASRH awareness raising (street dramas, rallies, quiz contests, condom sensitization games.. etc) were held and attended by 23,353 A/Y. Program & activities were disseminated through newspaper, radio & TV at local / national level, and through Hamro RHIYA Club program to reach further poeople and areas.

3) To enhance access to quality SRH information & services for A/Y, the project established 15 YIC in collaboration with local youth clubs, provided ASRH related IEC & games' materials and formed committees to run YIC activities. YIC serve as resource centre for enter-educating activities & meeting points to discuss and share SRH information / experience. By the end of the project 44,565 A/Y visited YICs, 707 queries were received through YIC letter boxes, 53,253 condoms were distributed and 4104 A/Y received counseling service. In addition, 15 YFSDP were also established in collaboration with GoN and operated at local GoN health centers. A series of training were provided to health service providers who gave in turn gender sensitive youth friendly treatment, counseling and referral services to 7346 A/Y. To reach out of school A/Y, the ASRH peer education manual was developed by experts, was field tested through a series of meetings / workshops and distributed to RHIYA partners / others. In total 23,707 A/Y were contacted by PE including 1485 out of school peer group members. 300 additional PE prepared at the end of project for sustainability & more than 21,000 students were given SRH knowledge by trained teachers.

4) To enhance AMK & project partners’ capacity to manage / sustain the activities: Various activities were held from community to international level to give staff exposure, ASRH knowledge, advocacy, managerial capacity & strengthen their ability to handle the project successfully. Depending on the needs, these activities included trainings / workshops of different lengh (from days to weeks), on a variety of topics (admin & finance, M&E, KMS, YFSDP / YIC, FP & HIV/AIDS / STI, VCT counseling, peer education, GBV, girl trafficking, community mobilization, drugs, school management training...etc.) The beneficiaries were project staff from all levels including managers, assistants, YIC management committee members, youth mobilisers, trainers, PE, teachers, health service providers…etc. For example, the workshop on HIV/AIDS sensitized participants and prepared them to advocate & develop related programs. Moreover, exchange visits were organized within the 3 project districts with a total of 134 participants to share experience, best practices, challenges faced. Central level project staff regularly made supervision & monitoring visits, provided feedback / guidance to district / VDC staff, and managers presented activities / lesson learned during various planning / coordination meetings.

Lessons learned. Project implementation: Involvement of stakeholder in the project creates ownership of the program and led to advocacy on its favour. ASRH policies, programs & laws were introduced at national level, abortion was legalized & HIV/AIDS related policies developed owing to the project. Sign of success, there was a demand for a replication of RHIYA activities in other areas. It was realized it is best to organize exchange visits it in the middle of the project period so best practices learned can be implemented. In addition, alternative plans / flexibility of staff & population were helpful to minimize the negative effect of the strikes and blockades.
Youth Information Centres (YIC) became an attraction: Not only A/Y but adults used YIC as a resource centre & service delivery outlet, which is an indicator of sustainability. Their involvement in activities minimized the generation gap. Besides, publication of wall magazine was very helpful to share the stakeholders' experiences, learning and increase A/Y knowledge. However there should be more income generating activities in the YIC such as sewing & cutting, to motivate A/Y to continue in the program. One YIC per VDC was not enough due to the increased number of users and VDCs’ topography & there was a lack of new / sufficient IEC materials in the YIC because of the lack of budget.

Peer education / youth involvement developed A/Y’s capacity to run interventions in the future. The RHIYA youth camp gave A/Y a forum to express their hidden talents: competitive events showed their increased level of confidence. Youth volunteers got opportunities because of increased facilitation skills: one female youth mobiliser was promoted to supervisor position and a female PE was hired as a facilitator by another organization. It was realized that there should be at least 2 or 3 trained PE in each group so that activities would not be interrupted in the absence / dropout of PE. A/Y expected financial benefits including free medicines, but since they did not, there was an increased dropout of youth involved.
ASRH: Upgrading YFS knowledge and skills of existing local level government health service providers will help sustain the program. Similarly, the project expected that the trained teachers will use their techniques to teach ASRH issues after the project is over.

Partner profile. Aamaa Milan Kendra (AMK), a national level NGO, was established in 1975 with the main objective of developing and promoting the socio-economic and health status of grassroots level women. AMK has a well developed infrastructure with 59 local branch units in 19 districts run by a limited number of paid staff and more than 5,000 dedicated volunteers. In the past AMK has implemented activities in the field of non-formal education, women's entrepreneurship and income generating activities, and reproductive health, family planning and nutrition programmes. Their mission with RHIYA was to develop community actions for improved youth sexual reproductive health.

Contact: Aamaa Milan Kendra Lalitpur Nepal, Tel: +977 1 5521716, +977 1 5550298;
Fax: +977 1 5521716