|Community Pathways to Improved Adolescent Sexual and Reproductive Health|
A Conceptual Framework and Suggested Outcome Indicators
Written by the Inter-Agency Working Group (IAWG) on the Role of Community Involvement in ASRH
Involving communities in development is good practice, because community members know their own needs and understand issues that influence their health. For more than 35 years, community involvement has been seen as essential to the success and sustainability of development programs, including public health. Yet as resources for health programs become more limited and, indeed, even more restricted, in the case of reproductive health and family-planning programs some may question if community-driven interventions are worth the time, effort, and resources.
One recent inquiry on evidence, commissioned by the WHO Health Evidence Network (HEN), involved an extensive literature review focusing on empowering approaches to health, including communitywide participation. A wide range of outcomes were identified - at psychological, organizational, and community levels, and within families, programs and services, and other spheres. While very few researchers used designs ranked as ‘strong’ in the traditional evidence grading system, the author concludes that evidence exists “based on multi-level research designs that empowering initiatives can lead to health outcomes and that empowerment is a viable public health strategy” (Wallerstein, 2006).
There remains a need for more rigorous research designs to establish better empirical evidence of the contribution of community involvement to health outcomes, including evaluation research of adolescent sexual and reproductive health (ASRH) programs, which address socially-sensitive adolescent issues, and need to involve youth, adults, and the larger community to gain support and be sustainable. At the end of the YouthNet1/CARE technical consultation on the role of community involvement in ASRH, participants affirmed the need to articulate more clearly relationships between community-involvement processes and adolescent sexual and reproductive health (ASRH) outcomes, and the impact of participation on individual behaviors. Recognizing the wide range of community involvement outcomes, ASRH programs need to measure social-change effects that result from involved communities (e.g., girls allowed to stay in school instead of marrying early) as systematically as are individual and structural changes. To further thinking on these program and measurement issues, the Inter-Agency Working Group on the Role of Community Involvement in ASRH was formed at the end of the 2005 YouthNet/CARE technical consultation, with a mandate to develop a conceptual framework and propose outcome level indicators that articulate and measure the full impact of community involvement in improving ASRH.