Improving Utilization of SRH Services by Adolescents & Youth in Nepal

Project Profile. SPN implemented and executed the RHIYA program in Nepal from September 2003 to September 2006 with the aim of improving the SRH status, practices and behaviour of A/Y and increasing utilization of SRH services by A/Y in project areas. The project was implemented in 4 districts areas: Banke, Parsa, Chitwan, and Jhapa. From each of the districts, 5 small administrative units (VDCs) were selected for service provision.
SPN targeted underserved / marginalized A/Y with a high unmet need for SRH services and information through static, mobile and outreach activities. Over 100, 000 A/Y benefited from the project. The project also focused sensitization and orientation activities for health service providers, pharmacists, front line health workers, and gatekeepers like parents, teachers, community / religious leaders for creating enabling environment and support. Peer approach and IEC materials further helped to reach SPN goals.
Mainly, the project established 4 youth friendly service centres (YFSC) providing a full range of quality Family Planning (FP) and SRH services. SPN also established 16 youth information centres (YIC) which provided counselling on FP/SRH and other health related issues, and referred A/Y to health facilities for higher level of services. The YFSC teams were well equipped to address A/Y needs and had full time employees for a better effectiveness.

Strategy. The RHIYA program in Nepal aimed to empower A/Y with life skills and appropriate information and education on SRH and rights issues. The key strategies adopted by SPN to implement the programme were based on community sensitization on ASRH issues, peer education, need based IEC on SRH & HIV/AIDS, increase access to youth friendly SRH services for A/Y, and sustain the program.
SPN strategy brought up positive changes among community gatekeepers and youth as they could speak openly and were skilled on SRH owing to mass communication, group / advocacy meetings and educational visits. Similarly, the project developed various IEC & promotional materials and established linkages at VDC, district and central levels to create enabling environment for support of SRH/HIV activities. SPN also developed YFSD guidelines in English and Nepali and distributed it to all RHIYA partners to implement YFS at their level and also to bring uniformity among implementing districts.
The implementation modality of RHIYA by SPN was undoubtedly effective because many other organizations working in similar field tried to replicate it. Furthemore the logical framework and strategic planning was revised annually to be consistent with the country log frame; this led to the incorporation of 54 more PE to the 18 already working, and to the addition of 12 YICs to the 4 already existing. Moreover, SPN’s designed strategy fulfilled its sustainability objective: 72 PEs are still working for the mobilization of peer group members in the community, all YICs will be handed over to YIC management committee and regular outreach services will be continued through YIC by SPN.

Outputs.
1) Increased community & family support for improving ASRH and actions to prevent HIV/AIDS among A/Y: To create enabling environment, meetings/discussions and orientation programs were conducted wherein 1,271 community gatekeepers including adults, parents, school teachers, community leaders, and GoN health service providers were provided with ASRH/HIV understanding. Staff & peers involved the community to get its support, including in the 114 advocacy events conducted during special events attended by 4,697 people. Similarly 114 events were jointly organized with RHIYA partners & GoN officials to sensitize community members on ASRH. To strengthen linkages & coordination among parallel I/NGOs, SPN conducted joint activities like gynaecological camps, blood donations & regular immunization programs, and attended 33 district level meetings of RHCC organized by district public health offices for linkage development with other NGO /GoN.

2) Enhanced knowledge and awareness on SRH and HIV/AIDS among A/Y: To reach this goal, the project adopted the PE & peer group approaches for a snow ball effect: 1047 group discussions on SRH were held wherein 19,654 A/Y participated, 120 peer groups were formed and about 3000 A/Y enrolled as peer group members. Also, 51 orientation sessions were conducted for peer groups who organized different activities with district coordinators & teams, such as quiz (105) debate (333), or sport competitions. SPN also provided training to 80 teachers and 80 health service providers who were then able to conduct 458 ASRH sessions for 31,184 in /out of school A/Y. Furthermore, 405 ASRH video shows were shown to about 10,000 A/Y in YFSC & YIC and SPN run 32 episodes of radio program in national grid to answer SRH questions. Moreover 42,785 copies IEC materials on ASRH were distributed to A/Y including newsletters and booklet. Also, exposure visits were organized to national consultation meetings and YIC to observe other partner NGOs’ activities.

3) Enhanced access for quality SRH information and services for A/Y: 4 YFSC were established with a team of 7 full time employees providing counselling on FP / SRH, STI, HIV / AIDS & safe abortion, or providing temporary FP methods, check ups, test & referral and IEC materials. All YFCS also had a box where A/Y could raise anonymous SRH related questions which were answered by posting papers in meeting rooms. SPN also developed a YFSD Guideline in English and Nepali, printed 5,000 copies of it and distributed it to all partners, I/NGOs and GoN health centres. In addition, SPN established 16 YIC with local A/Y clubs, providing IEC & edutainment materials, newspapers and running outreach based ASRH activities such as peer group & parents meetings, focus groups discussions, mass rallies, advocacy/ awareness raising events. Throughout the project period, 53,711 A/Y were contacted by PE for sharing SRH skills, 35,601 condoms were distributed and 2,419 A/Y were referred to health institutions such as hospitals for the advance treatment on STI/ RTI.

4) Enhanced organizational capacity to manage and sustain SRH services & information for A/Y and activities promoting HIV/AIDS prevention: To reach this goal various trainings were provided to SPN staff & partner NGOs’ service providers like on YFSD, life skills / peer education, SRH & GBV counselling or infection prevention & management. SPN supported partner NGOs technically to train 222 GoN health service providers and staffs on YFSD & IPM and provide refresher trainings. SPN also received support from BPMHF & FPAN to provide training & refresher training on ASRH to 80 teachers. In addition 224 PE and 789 peer group members were trained on SRH activities & and 16 managerial / officer level staff of partners received training on global & national issues of HIV/AIDS. Altogether the project trained 1870 people. Also, to ensure the track and output of the program, monthly review meetings were held by UPSU & RHIYA partners and to record and report activities, SPN adopted its own MIS tools like intake / outreach register, peer educator's diary or training. It reported all the activities / performances in the PTRS and used various M&E tools like centre audit check list, client exit interview forms, pre and post test training questionnaires.

Lessons learned. Project implementation: Community involvement process takes some time to gear up but with continuous efforts to sensitize key community members and GoN service providers, their participation/involvement in the activities increased so as their support to the project. Similarly, mobilizing PE, peer group members and outreach workers were effective in overcoming A/Y hesitations; Turn over of peer group members was mainly due to high mobility among youths due to armed conflict, political instability and for further education.

SRH services and information: A/Y prefer confidential and separate counselling rooms A/Y prefer talking about their problems and having services from people from the same sex. The question boxes hanged in front of YIC & YFSC was also effective to respond their queries. Most of A/Y prefer separate service and information because YIC provide SRH information to A/Y whereas YFSDC deliver the FP/SRH services & counselling in the community; SPN upgraded the YFSCs to continue the services but if the client flow is not increased and additional support is not available in future, that may hamper to continue sustainability.

Activities: Edutainment activities are more effective than orientation lectures: A/Y do have curiosity to know about SRH issues but are shy. If they are involved in edutainment activities like street drama, quiz / song competition etc, they feel more comfortable to talking about it; Skills generating activities are to be incorporated in the project: A/Y have high ambitions and are in search for opportunities. Since the project had limited activities (focused on SRH rather than life skills), they used to turn away after involvement for some time; IEC materials are to be developed for A/Y since most of the IEC materials are the same materials being used for adults, and because there is great variation of A/Y in their age, knowledge and experiences.

Partner profile. Sunaulo Parivar Nepal (SPN), established in 1994, is a non profit, non religious NGO committed to cover the unmet FP/SRH needs of Nepalese people through static clinics, outreach activities and mobile voluntary sterilization camps, coordinating with the government and local NGOs. Its main goal is the prevention of unwanted pregnancies/births and its mission is to enable people to have children by choice and not by chance. SPN aims to provide quality services that are accessible, affordable, and reliable to the underserved community. It has provided services to over 800,000 clients to date.

Contact: Sunaulo Parivar Nepal (SPN), Shiphal, Kathmandu, Nepal; Tel: +4472811, +4477739; Fax: +4472348; Email: msi@msinepal.enet.com.np