Education session in Qila Saifullah, Balochistan

Program for the Protection of Young Adults in Selected Areas of Pakistan

Project profile: PAVHNA implemented the RHIYA programme in two districts of Pakistan namely – Muzafarabad and Killa Saifullah, since April 2004. It aimed to contribute to the improved ARH and overall well-being of A/Y in Pakistan, to promote responsible SRH behaviour and increase utilization of youth friendly information, counselling and services, especially for girls, who are restricted in their mobility at the onset of puberty and are not even allowed to attend school in Killa Saifullah.

PAVHNA sought to advocate for RH education, services and rights for young people through the establishment of Youth Friendly Centres (YFC), schools and Madrassas corners, the conduction of outreach interventions, and above all, through raising community stakeholders’ support for ARH interventions. However, these plans were somehow changed by the occurrence of an earthquake in Muzafarabad district on 8th October 2005 which destroyed 70% of the health facilities and provoked high risks of infection among girls due to a lack of hygiene and lack of clean water.

Strategy: PAVHNA identified that cultural / traditional norms and practices varied in the target areas, but adopted the same people centred approach to implement ARH interventions effectively. This strategy was based on engagement and capacity building of gatekeepers and empowerment of young people. PAVHNA thus improved the communication skills of its team and volunteers through developing communications and advocacy packages. This aimed at undertaking advocacy and mobilization, and creating acceptance and ownership the project among youths and community. Also, meetings and consultations with groups of gatekeepers and young people were held to assess their needs and plan interventions accordingly. As a result, PAVHNA established 30 YFC (20 in Muzafarabad, 10 in Killa Saifullah), 15 each for male and female youth, 12 school and 12 Madrassas corners to provide ARH education and services and generate safer health practices.

The strategy was a bit modified for Muzafarabad district as per the needs and propositions of the population. The programme focused on rescue operations and relief activities to take over the loss of the YICs and equipment, furniture and supplies after the earthquake. MSS established a base camp in its district office to provide immediate quality medical and emergency care services to the victims. However, PAVHNA did not let the ARH aspect down since it rebuilt YICs in prefabs structures, developed and distributed hygiene kits for females in earthquake hits areas, and encouraged the conduction of street theatre on RH issues as a means to provide information to youth and community members and recreational activities at the same time.

Outputs: 1) Increased political, community & family support for A/Y interventions: PAVHNA adopted a culturally sensitive approach to engage, sensitize and gain support from gatekeepers. Messages were designed to take the Quran’s teachings into consideration to convince gatekeepers, particularly religious leaders of the need of ARH interventions. Seminars on “Islam & RH” moderated by religious scholars attracted large number of people with active participation of men & women. Generally, implementation of the project was facilitated by on-going dialogue, orientation meetings and advocacy events / meetings through which stakeholders were mobilized and provided with ARH knowledge. Signs of gatekeepers’ support for RHIYA, 15 girls from Killa Saifullah and 15 girls and 15 boys from Muzafarabad areas got the permission to go to RHIYA National Youth Summit in Islamabad, and community members gave contribution to install prefab structures of YFS after earthquake.

2) Improved awareness & ARH knowledge among A/Y: To reach this goal, several tools were used including health education sessions at YFC, schools, Madrassas, workplaces / community meeting places, message dissemination through dialogue forums between gatekeepers and young people, banners and audiovisual materials, and awareness raising activities such as theatre activities or health festivals. However, the most innovative tool was the development of IEC material in a culturally appropriate and comprehensive manner, covering topics such as puberty, menstruation, STI/HIV-AIDS, pre-marriage counselling, safe motherhood, FP, sexual abuse, GBV, rights of spouses etc. which were available in YFCs. In addition, PAVHNA developed a training-learning package which allowed PE, health / FP service providers, youth volunteers and community members for disseminating ARH awareness. The 780 PE formed were thus able to educate 24,642 young people on RH issues.

3) Improved access to quality youth-oriented services: Extreme care was given to ensure sufficient space and cleanliness at YFC, and make all the services youth friendly, affordable, confidential and accessible. Individual medical consultation & treatment were given to youth for issues such as GBV, abortion, maternal health, masturbation, menstruation, STI and FP. After acceptance, YFC also provided free contraceptives. It has to be noted that youths at YFC level, prepared all work plans for their activities which were therefore youth friendly. In addition, after the earthquake in Muzafarabad, medical and base camps established provided medical and health services to 39,000 patients. PAVHNA also trained some YFC/NGOs staff, health service providers and emergency relief workers on psychosocial and trauma counselling. It allowed 53,835 people affected by the earthquake to receive such support.

4) Enhanced technical, planning & managerial capacity among GoP and local NGOs/ CBOs in the provision of ARH information & services: PAVHNA first invested in capacity building of staff, volunteers and community gatekeepers to implement and manage interventions, disseminate awareness and educate youths and communities on ARH. This included trainings on counselling & communication, on ARH training-learning and on advocacy for A/Y. Altogether 5347 persons were trained including on M&E system (PTRS) & KMS. PAVHNA developed a training manual for mental health of natural disasters victims and provided ToT on it. Copies were produced in Urdu and English versions, and shared with relevant stakeholders. In addition, PAVHNA developed a sustainability document indicating key strategies used in target districts, with the expectation that activities would continue after the RHIYA.

Lessons learned: A cultural sensitive based approach was essential to implement the RHIYA in Pakistan. Discussing RH with unmarried A/Y is taboo and extremely sensitive, therefore constant meetings and communication was important to convince influential leaders that the project would respect cultural norms and traditional values. Implementation was only possible when raising confidence of the communities through great diplomacy, discretion, awareness of local cultures and a never ending supply of persistence & patience. It took however some 6-15 months for its teams to neutralize opposition.

Involvement of stakeholders can advance ARH promotion in conservative context.. Involving GoP’s departments and district governments created a supportive environment: the year 2005 was declared as the year of youth by the GoP. But most importantly, engaging high-ranking and influential local religious leaders is essential to implement ARH activities, because they give a “moral support” for community participation. This is the most effective mode of changing perceptions towards RH.

Provision of RH information & services: availability of ARH information, counselling and advocacy contributes significantly to increase demand for ARH services. Skill development and entertainment activities, particularly for girls, contribute to empowerment and increase participation in YFC, schools & Madrassas corners and outreach interventions. Theatres are the best way of communicating mass messages, not only for A/Y but also for elders. IEC material on “Islam and RH” was helpful in neutralizing opposition and creating realization among community members of significance to address ARH issues.

Partner profile: Pakistan Voluntary Health & Nutrition Association (PAVHNA) established in 1979 has been an umbrella organization for nearly 30 NGOs & CBOs members in Pakistan with the objective of improving the general health, nutrition and reproductive health, through a multifaceted approach. PAVHNA also plays an important role in advocacy to deal on a broader based platform with issues of adolescent reproductive health and related issues. PAVHNA strengthened its work to increase A/Y’s access to reproductive health information, education, counseling and services when it became one of the implementing partners in the first RHI phase. This justified the continuation of PAVHNA as a partner for the RHIYA.

Contact: PAVHNA 9C, 18th Comm. St. Phase-2 Ext. DHA Karachi Pakistan Tel: +021-5801401-3 Fax: +021-5887859