Working with Young People on Sexual & Reproductive Health

Project Profile. Family Planning Association of Nepal (FPAN) implemented the RHIYA from September 2003 to the end of August 2006, in 30 VDC of 5 districts in rural areas where FPAN was already operational: Kailali, Kanchanpur, Dang, Dhanusha & Kavre.
FPAN aimed to improve SRH practices / behaviours among A/Y & increase the utilization of SRH services by A/Y in these areas, focusing primarily on in & out of school A/Y aged 10-24 years, that is to say 15% of the total A/Y population in the VDC.
The project sought to include A/Y from the Tharu community in Kailali, Kanchanpur & Dang districts, while in Dhanusha district Maithili community was covered. The latter is a backward community wherein women are under the veil, are restricted in their movements, have no decision making power and their basic reproductive rights are encroached upon by males. In Kavre district, beneficiaries are of mixed communities selected from neglected, underserved &vulnerable groups deprived of education, health and employment opportunities.
FPAN worked towards building the capacity of CBOs & NGOs working at grassroots level and to create a conducive and supportive environment in the project communities for undertaking A/Y health & development initiatives. To reach this goal, FPAN uniquely focused on life-skills training for A/Y in order to improve the SRH status of young people and lead to a healthier society better equipped for the challenges of development in Nepal.

Strategy. As a component project, FPAN contributed achieving outputs related to RHIYA strategic framework. FPAN strategic plan focuses on 5 thematic area including ASRH, HIV/AIDS prevention and management, safe abortion, advocacy on SRH rights and access to SRH information & services to marginalized and disadvantaged groups.
To reach this goals, the project upgraded RH infrastructure creating activities. One of the most effective strategies was the development of Youth Friendly Service Delivery Points (YFSDP) providing SRH services and counselling. It was a unique feature of the project. Also, Youth Information Centres (YIC) & school based clubs were seen as very productive and useful for youth as they served as forums for meeting friends, holding interaction and dialogue on matters relating SRH, and obtaining education, information and counselling.
Another strategy of the project’s design was the mobilization & participation of community and A/Y in programme management and the strenghtening of institutional capacity of existing CBOs, school authority, staff & volunteers regarding resource development. This structure was appropriate as implementation was facilitated by teachers, students, community leaders, women volunteers, local authorities / stakeholders and A/Y. A/Y were trained to be PE to provide SRH education within their own communities / schools.
The project also took into account the RH strategy of the GoN as to complement and supplement existing RH programmes. FPAN established strong linkages/networking with the aim of sustaining ASRH support policies and handing over the programme.

Outputs.
1) Increased political, community & family supports for ASRH interventions & prevention of HIV/AIDS: The project attracted communities in a productive way through meetings, interactions, discussions or trainings. 58 sensitization / orientations to A/Y, CBOs, parents and other relevant stakeholders to make them aware of the importance of SRH/HIV-AIDS interventions. To strengthen linkages with GoN organizations & CBOs at village / district levels, dissemination meeting for briefing / experiences sharing were organized. Also, planning and coordination meetings, follow ups and sharing of experience were held at various levels with line agencies like DHO/DEO and also with A/Y sport clubs / CBOs /GoN health staff & other stakeholders to develop action plans aimed for ASRH interventions. Moreover different ways of advocating for ASRH were held at national / international level like 12 national reading campaign, 14 International women’s day, 17 condom day... celebrated through rallies, interactions bills / hoarding boards, wall paintings, & different competitions. To strengthen linkages between FPAN, RHIYA partners & GO/NGOs joint actions were conducted on the occasion of marking days.

2) Increased awareness and improved SRH knowledge among A/Y: Following a baseline survey & needs assessment on the ASRH situation, the project implemented awareness-raising programs on ASRH, including on STI/HIV/AIDS, GBV & girls trafficking. Action plans were developed with involvement of A/Y in order to fit the programme with their needs. The project disseminated different types of IEC / BCC materials (5000 pieces) and developed recreational activities (263 street dramas, 193 video films observed by 79,833 A/Y..) & games (225 copies of Indreni game reprinted) to advocate for ASRH issues. In-school & out-of school activities (peer group formation, orientations, trainings...) were also carried out. In addition 7800 pieces of promotional materials were produced (caps, T-shirts) to disseminate ASRH messages. FPAN also collaborated with BPMHF to develop the manual training guideline for teachers & operational guideline for YIC in order to spread SRH knowledge efficiently among A/Y through group discussion, health education classes, youth camps etc. Moreover, exchange visits were organized, audio visual material developed & radio program (organized by UNICEF) utilized at YIC, to share lessons learned on a wider scale.

3) Improved access to quality youth oriented SRH services: Appropriate locations were selected to provide quality SRH services: YFSDP&YIC were upgraded for continuous SRH & counselling services including the distribution of 67,103 condoms without registering clients' names in order to increase the service seeking behavior among A/Y. Through YFSDP 25,871 (6,867M;19,004F) new clients benefited from FP, safe abortion, like skills information & STI/ HIV prevention and referral to FPAN. 7 new YIC added to the 13 existing, served as resource centers for YFS, gender sensitive information, provision of IEC & sport materials, counseling & referral. Monthly meetings on YIC management committee & 191 quarterly meetings of advisory committees were held to improve the quality of services. 7 CBOs attended meetings & adopted YFS guidelines to run the YIC efficiently. Moreover, youth clubs (YC) were set up in 30 schools to benefit both teachers & students through ASRH/HIV-AIDS & life skill education/IEC materials, SRH classes program to 5472 school students, questions boxes in school libraries and teachers training on communication skills. Youth, sport clubs & other CBOs groups were selected to form 180 peer groups. They contacted 42,789 A/Y on SRH.

4) Enhanced technical, planning and managerial capacity among GoN & local NGOs / CBOs in the provision of ASRH information & services: Effective planning, monitoring, management system (i.e.PTRS) & sound knowledge management system (KMS/X- change) were established to provide staff/volunteers, CBOs with on the job guidance, follow ups, M&E and supersvision meetings to improve plans, review progresses & address issues. Branch youth community / management committee / advisory committee were formed & selection criteria for YIC locations developed to plan & manage activities effectively. The 13 existing YIC were upgraded with a financial /administration & personnel management system consistent with EU/UNFPA rules / regulation. Moreover, the capacity of staff (including senior officers), A/Y, CBOs & different stakeholders was enhanced through various trainings, workshops/orientations with the aim of implementing & sustaining project activities. For example, 143 teachers participated in life skill based training / refresher training on ASRH, HIV, GBV & GT programme; 20 service providers & counsellors were trained on YFSD; clinical / non clinical staff received a training on universal precaution and infection prevention ; 24 staff / volunteers& 180 PE & 1260 peer group members were trained on ASRH, GBV & life skill, and various ToT were held to provide high quality information & services. Exhange/observation visits and study tours were also organized to expose CBOs & A/Y with different program actvities and therefore increase their capacities & skills.

Lessons learned. Design / implementation: There was a language problem: although some sessions were conducted in “Maitheli” some ethnic groups were not reached. Before creating new types of services, it is important not only doing a needs assessment but also attempting to determine whether identified needs actually translate into a manifest demand for such services.

On going coordination / collaboration is important: linkage with local GoN agencies, NGOs and community stakeholders is important to increase access to SRH information & services to A/Y, avoiding duplications and reducing costs: that leads towards sustainability. Regular meetings, supervision & monitoring visits are helpful to address problems. Networking helps to narrow down gaps in the service delivery and strengthen capacities of partners through sharing facilities and expertise.

SRH: Community stakeholders contributed to sustainability through donation of land for YIC / YFSDP construction / clinic space free of cost & active participation. Also, the YIC guideline & teacher manual were useful and popular beyond the programme. Local CBOs will hand over the YIC & YFSDP clinic will continue through FPAN core grant. To further sustain YIC & make it more acceptable, education on issues such as hygiene or nutrition should be introduced. However, in IEC activities / materials for A/Y, there should be more emphasis on the positive aspects of intimate relationships, sexuality & related subjects.

Peer education/ Youth involvement: A/Y should not only be consulted in the planning & implementation of youth related projects but also be involved in decision making processes. Expectation of A/Y with the project is high as they are demanding income generating activities to increase their personnel income. In developing countries where people marry and become parents at young ages, these people should be approached as adults. Concerning PE, they not only provide participation of A/Y in the programme but also maximize the project impact. Their function and treatment should be extended to develop and implement IEC/BCC activities. To reduce high drop of peers involved, the project envisaged to implement skills development program for selected A/Y and exchange/ exposure visits to motivate them.

Partner profile. The Family Planning Association of Nepal (FPAN) founded in 1959, became an associate member of the International Planned Parenthood Federation (IPPF) in 1960 and proceeded to attain the status of full fledge member of the IPPF in 1969. FPAN is providing a range of family planning, SRH and developmental services in the country. It is committed to the promotion of family planning services as a basic human right as well as a means of ensuring the health and well being of individuals and families. Emphasis is given on counselling and promotion of safe motherhood and birth spacing methods, thereby complementing and supplementing the national programme of HMG/Nepal in collaboration with other NGOs, and bilateral and multilateral agencies. Under the RHIYA, FPAN focused on the creation of a favourable environment to increase the involvement of youth in the programme planning and implementation, and ensured availability / accessibility of appropriate information, education, counselling and other services to meet A/Y SRH needs.

Contact: Family Planning Association of Nepal, Pulchok Lalitpur, Nepal; Tel: +5524440, +5524670, +5524675; Fax: +5524211, +5524675