Improvement of SRH & Prevention of HIV/AIDS & Drug Abuse Among A/Y in Urban Poor Communities

Project Profile. EHDAG implemented the RHIYA in urban poor communities of Pokhara (Kaski) and Dharan (Sunsari) districts targeting slums, squatters and other urban marginalized & deprived communities including so-called Dalits. EHDAG’s general objective was to improve the SRH status, practices & behaviour and utilization of SRH services for A/Y aged 10-24.
The project mainly addressed the need for A/Y awareness on SRH, HIV/AIDS and drug abuse and the significant wide gap between knowledge, attitude and practices (KAP-gap) among the A/Y with youth friendly services (YFS), therefore making up for limited programs / services addressing these issues. EHDAG also focused on the potentiality to mobilize local resources for sustaining successful approaches beyond the RHIYA.
EHDAG’s main achievements were to develop an enabling environment with orientations, days marking, interactions, street dramas, distribution of IEC materials and linkage development; to enhance A/Y awareness raising with one to one and / or group education on HIV/AIDS or drug abuse, or through community wall magazines, SRH letter exchanges, video-shows, NFE, tin-trunk libraries, distribution of IEC materials and youth information centres (YIC). It also increased accessibility of services with contraceptives, iron tablets, safe delivery kits, counseling, referrals, follow-ups and youth friendly service delivery points (YFSDP). To reach these goals, EDHAG focused on capacity building & sustainability with A/Y and community leaders training, exchange/exposure visits, linkage development and community mobilization. EHDAG covered around 11,131 A/Y and 20,000 other populations.

Strategy. By identifying certain criteria among A/Y aged 10-24 such as high risk situation, low level of SRH indicators, poor access to SRH information & services, lack of opportunities to link with existing SRH facilities, EHDAG was able to design a strategy & an implementation modality. It gave special attention on community participation, creating local ownership, integration of project services or activities with other services / facilities, volunteer activities / community involvement, generation of community funds and linkages development.
Initially, EHDAG planned to carry out all the project activities on its own. However, EHDAG designed a concept of community centres in each of the project site communities, to be taken care by male and female A/Y groups. These service delivery points (SDP) aimed at providing A/Y with services of contraceptives, IEC materials, counselling, primary health care and gathering of A/Y for meetings and developing community activities. These activities were shared with all RHIYA partners including UPSU & UNFPA during regular meetings.
Slowly, the establishment & operation modality of SDP was converted into “Tin-trunk SRH services”: EHDAG started 4 YFSDP with municipalities & 4 YIC with local clubs, in order to develop local stakeholders’ participation. Setups and services also were upgraded. This strategy was designed in order to continue ASRH activities after the end of the project.
EHDAG also developed a concept of sustaining project services by developing volunteers, including peer educators (PE), managing community funds, making availability of free of cost working spaces such as community houses, school rooms or personal contributions and making availability of program materials such as contraceptives & IEC materials for low / free of cost with support of local organizations.

Outputs.
1) Increased political & community support for ASRH interventions and prevention of HIV/AIDS & drug abuse: To reach this goal, 847 advocacy meetings were organized by PE or/and EHDAG staffs with community advisory committees’ support. These included 591 stakeholder meetings, 16 community meetings (parents, policy makers & officials), observance of 94 special days such as the Condom Day and 143 others such as contests, street drama shows, etc. To improve gatekeepers’ support for interventions, EHDAG decided to enhance their understanding of specific ASRH issues: 60286 of them participated in education activities, including 16357 parents, 31497 community leaders, 90 teachers and 1342 others. Furthermore, 117 activities jointly organised by RHIYA partners & GoN officials helped to develop linkages at national level for ASRH support policies. These activities were advocacy events, training, workshops, network meetings and others such as days marking or rallies. Local political leaders (455) were also involved in about 300 activities in the project such as advocacy events, steering group meetings, official meetings and other activities.

2) Increased awareness & knowledge on SRH, HIV/AIDS and drug abuse among A/Y: Here, the strategy was to divide common but specific tasks such as the development of ASRH IEC material among all RHIYA partners in Nepal. Concerning EHDAG, it adapted training manuals such as “PE’s Training Manual” & “Counselling Training” and developed booklet on “Meeting the generation gap”& leaflet on “Advocacy for ASRH”. IEC materials & also media messages were disseminated among partner NGOs, PE, YIC & YFSDP for /by A/Y as per needs. PE contacted 64,879 A/Y (34,373 M & 30,506 F) for RH sessions & delivered 20708 pieces of IEC materials on SRH, HIV, drug, life-skills, GBV & others such as hygiene… etc. Moreover, other ASRH awareness activities were implemented for A/Y and other community people, including by PE through one-to-one basis, group / mass education and other methods. These activities included 62 street drama shows, 116 video shows, 11 parents / A/Y interaction on SRH, 615 issues of SRH wall magazines, 3407 SRH letters written by the A/Y…etc. Also, 22 SRH non-formal education programs were organized in 16 communities. Around one third of the participants were female A/Y.

3) Improved access to quality youth oriented SRH services: 2242 A/Y (868 M & 1374 F) consulted services providers for treatment / test on family planning (FP), abortion, STI / HIV-AIDS, 1830 A/Y (780 M & 1050F) received counselling services; 284 A/Y (81M & 203F) were referred for FP, abortion, STI/ HIV-AIDS, drug abuse, sexual problems, GBV and others such as fever, burns etc., by service providers at YFSPD, volunteer A/Y & YIC, and especially by PE. Moreover, there were 293 (23M & 270F) clients receiving treatment / test services, counselling services, referral services & other services such as primary health care, SRH education, IEC materials, condoms & pills. Also, 230 new clients (21M & 209F) received services from SDP. Furthermore, PE contacted 10,4718 A/Y (56541M & 48177F), and most of the contacts were repeated more than twice for education on FP, STI, HIV/AIDS, delivery / pregnancy / abortion, GBV and drug abuse. Similarly, other education such as infertility, life skills, general health was provided to 18959 A/Y.

4) Enhanced technical, planning and managerial capacity among local NGOs/CBOs and community leaders in the provision of ASRH information & services: Altogether, 1542 volunteers & staffs (649M & 893F) of implementing partners participated in training programs to provide YFS. They were 6 medical staffs (1M, 5F), 1469 PE (618M, 851F), 53 local support group (CAC) members (23M, 30F) & 14 staffs (7M, 7F). Also, 10 PE participated in FP training and other 1532 participated in M&E, Participatory Monitoring, TOT on PE, PE, Meeting conduction & record keeping, street drama, advocacy & planning, counselling wall magazine development, global youth program, etc. Training programs were organized in 19 different subjects for PE & 3 subjects for CAC members.

Lessons learned. Community participation in the project is possible if involved from the beginning. Community stakeholders participated in decision-making for selecting communities, potential A/Y & community advisory committee (CAC) members: it created ownership of the project, especially and was very helpful for sustain the project. Community people played a vital role in coordinating meetings with GoN’s officials as they expressed their SRH needs, made sincere requests for supporting the project. Involvement of parents encouraged A/Y to get involved in the project, and involvement of A/Y gave a snow-ball effect towards other A/Y.

ASRH: EHDAG got contraceptives and SRH IEC materials supports from the govt. & NGOs as results of linkages. Also, A/Y vs parents’ interactions help to convince that A/Y must be given SRH education / support the project. In addition sport materials, daily newspapers & radio attract A/Y and encourage them reading IEC materials, interacting on SRH and discussing on related issues while staying in YIC. Wall magazines interest A/Y because articles & messages were developed by A/Y with similar interests. Project news-bulletins are effective means of advocacy for ASRH programs since A/Y published in it their work progresses or SRH articles/ interviews. Those news-bulletins gave community people, (N)GOs/ CBOs and stakeholders a deeper insight on RHIYA program.

Activities/events: such as trainings, gatherings etc. should be organized on weekends / holidays because A/Y are busy during weekdays with school or work. Attention must be given on availability of time for both school going and out school A/Y. Also, street drama is an effective mode of mass ASRH education, especially with illiterate and elderly people. Similarly, PE gathering strengthened relationship between PE & A/Y since they shared their activities, progresses and future plans. Being district level events, those were some of the biggest and most important ones in the project life. A system for immediate replacement of PE must be managed in advance and it must be foreseen during the recruitment time of PE so that dropout is not affecting the project

Review/report of project: Periodic review is necessary to keep project in proper track for sustainability. It provides opportunity to monitor project status, ongoing track, effectiveness of activities, overview challenges faced, sharing lessons learned and collective planning. Also PTRS reporting systems made unanimous, clearer, and approachable to/by all the concerned parties and time saving. Reporting with unanimous data and information system with all other national and international RHIYA partners was the great support for KMS of the project.

Partner profile. Environment Health and Development Advisory Group (EHDAG) is a community-oriented non-profit NGO established in 1994 by a team of professionals with experience in community development. Its overall objective is to support and encourage disadvantaged communities to uplift their living standard through their own participation in activities related to community health & socio-economic development. EHDAG also focuses on strengthening and mobilizing community leaders, groups and institutions. EHDAG’s mission is therefore community development through community empowerment by capacity building and making people use locally available facilities.

Contact: Environment Health and Development Advisory Group (EHDAG) Subidhanagar, Tinkune Kathmandu Nepal Tel/Fax: +977-1-4484007 Email: ehdag@mos.com.np bpmhf@ecomail.com.np