Transitions: Community Participation
Volume 14, No. 3, April 2002
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By Amy Weissman, Youth Reproductive Health Specialist, Save the Children
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Participants agreed that most health services in Mangochi were not youth-friendly, and the youth identified issues that included long waiting times and lack of confidentiality.
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In Mangochi District, Malawi, Save the Children recognized that improving the reproductive and sexual health of the district's youth required changing community norms. Young people, in partnership with key adults, needed to participate in planning, implementing, and evaluating activities. First, Save the Children worked with the community to assess the needs of Mangochi youth. Focus group discussions with youth, parents, community leaders, service providers, and other key stakeholders identified concerns and perceptions about youth's reproductive and sexual health. Youth conducted focus groups among their peers, while adults conducted discussions and interviews among adults.
In a workshop, participants used the needs assessment data to identify priority issues, including sexual exploitation and violence, harmful traditional practices, and inadequate reproductive health services. During the workshop, representatives of young people's clubs, organizations working with youth, government officials, and religious leaders designed the Nchanda ni Nchanda pa umi Wambone (Youth to Youth for Healthy Life) project, using Save the Children's community mobilization approach. Although youth participated and some of their expressed concerns were among the priority issues, young people lacked the confidence and the authority to make their primary concerns heard. This experience underscored the importance of structuring planning sessions in such a way that those with less power have an equal voice.
Although influencing community norms required engaging key adults in all aspects of the project, Save the Children also believed that youth must "drive" the process. For example, young people exchanged ideas with health providers about issues that need to be addressed to achieve youth-friendly care. Youth and health care providers held dialogues in the seven health centers in the project area. Participants agreed that most health services in Mangochi were not youth-friendly, and the youth identified issues that included long waiting times and lack of confidentiality, such as health providers' reporting to parents when youth sought reproductive health care. The young people's suggestions regarding these issues—for example, maintaining confidentiality, assisting clients quickly, assuring privacy, and refraining from being judgmental —were included in a training course for health services providers. The training course also addressed clients' rights, including the right to information, respect, and confidentiality, and to make informed and responsible choices. As a result, young people began to seek out the trained professionals by name.
Recent evaluation indicated that using a community mobilization approach has been effective. When compared to baseline, male youth demonstrated significant increases in knowledge about STIs and HIV/AIDS as well as significant increases in condom use. Female youth reported increased abstinence. In addition, because the project focused not only on youth, but also on their social environment, the evaluation indicated changes in communication patterns between adults and young people. Significantly more males and females in the project area than in the control site reported talking with their parents about a romantic or sexual relationship. Community participation not only enhanced community ownership of the project but also ensured cultural relevance and increased sustainability. To promote adolescents' adoption of healthy practices, programs need to address youth and their social environment. In Mangochi District, community participation has been key to doing so.
Next Chapter: The Participatory Approach Improves Youth's Reproductive Health in Nepal
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Transitions (ISSN 1097-1254) © 2002, is a quarterly publication of Advocates for Youth—Helping young people make safe and responsible decisions about sex. For permission to reprint, contact Transitions' editor at 202.419.3420.
Editor: Sue Alford
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