Advocating for Adolescent Reproductive Health in Sub-Saharan Africa[PDF]

Also available in French in [PDF] format.

Many NGOs seek to involve young people in the design, implementation, and evaluation of youth-serving programs. Youth involvement provides the organization with valuable insight into the needs of adolescents. Youth involvement also builds the leadership and communication skills of young people. Creating effective youth involvement, however, is a challenging process, one that demands commitment and flexibility on the part of both NGOs and young people themselves.

Youth involvement is equally important in the development and implementation of an advocacy campaign. Young people can provide accurate insights into the effects of various policies, or lack of policies, on their peers, and can help an advocacy network better define its goals, objectives, and strategies. The presence of youth in all network events and activities serves as a reminder of the issues which bring the members together. Finally, young people develop leadership skills and confidence and gain work experience.

However, youth involvement is more than just young people being present at a meeting or serving as spokespeople. Young people should play as important roles in the network as do adult members, and they should participate in decision making, planning, and implementation of activities. A number of factors, however, create barriers to youth involvement.

• Cultural norms make young people reluctant to speak out and adults less likely to listen to them.
• Young people and adults may have difficulty discussing and planning activities on the sensitive topics of reproductive health and sexuality.
• Young people may lack some of the formal training in processes that adults have, which may inhibit their participation in setting goals and objectives and defining strategies.
• Adults frequently assume that they easily understand the attitudes and challenges of youth today.
• Finding suitable locations and times for young people and adults to meet can be difficult.
• Young people, particularly out-of-school, working, and street-involved youth, may be reluctant to spend a lot of time on activities for which they receive little or no money.

Young people are a tremendous resource for an advocacy campaign. Bringing young people into the process early and getting adults and youth to agree on some first steps to build their communication and collaboration will help create the foundation of a sustainable effort. Following are tips for working with young people and involving them in advocacy efforts.

• If the network or organization does not have direct access to adolescents, contact other YSOs in the community. Invite young people who work with those programs to come and speak informally about their efforts.
• Discuss youth involvement with other organizations and identify those which are successful at involving youth in their activities. Seek information and materials that will encourage youth involvement in the advocacy campaign.
• Find locations and times for meetings that are acceptable for both young people and adults. Young people, too, should be kept informed about plans and meeting times.
• Begin with activities that will help build communication between youth and adults. Young people may need time to become comfortable before speaking up in front of adults. Adults may also need to examine their beliefs about adolescents and adolescent sexuality before they are prepared to listen to young people's opinions on the topic.
• It may take time and effort to get young people to participate fully in the network. Work to help teens feel comfortable. Do not assume that, if a teen is not speaking, that he or she has no opinion. Ask youth to contribute during meetings and discussions. Be open and nonjudgmental about young people's insights and suggestions. Let them know that their involvement is important and valued.
• Provide training and mentorship to build the skills and confidence of young people. For example, a young person who has never participated in strategic planning may not be able to say much in a discussion about goals and objectives while a youth who has been trained in this process is far more likely to make a meaningful contribution. Young people may need information about adolescent health, the political situation, or reproductive health programs currently operating in the community. Young people may need training to become effective communicators and to feel comfortable speaking with the media or with policy makers. Providing young people with opportunities to build their skills helps expand the network's effectiveness.
• Obtain agreement of all network members that young people are equals. Youth should participate as much as possible in the decision making and should have the right to vote and hold leadership positions.
• Use the expertise of youth. Do not discredit young people's contributions as "idealistic." Young people are much more likely to contribute when their contributions are taken seriously.
• Be realistic in setting expectations. Some adults may be frustrated by the time and effort needed to integrate young people fully into the network. Be honest about your expectations for the project, the young people's contributions, and the network's benefit from youth participation. Trying to do too much at once may disappoint or frustrate everyone.
• Be prepared to offer support. Consider what is needed to involve a broad variety of community members, including youth, in the project. Support may include financial assistance, transportation, training, and information.
• Make the work interactive and fun. Like adults, young people are more likely to become and remain active in projects that are interesting and fulfilling.
• Do not make assumptions about any individuals, including youth.

• Young People Can Do All This—And More!
  Plan the strategy Do interviews with the media Plan a program Design educational materials Educate the community, other youth, etc. Write letters to newspapers Represent youth support for program funders Keep the network in touch with the trends and challenges of youth in the community	Plan and conduct a conference Speak to community leaders Evaluate a program Get other young people involved Conduct community interviews, research, or needs assessment Be a spokesperson for the network Help represent the network to funders Evaluate the friendliness of information and clinical services programs for youth

  Case Study—Youth Friendly Health Services in Lusaka, Zambia

  In Zambia, as in many countries, adolescent reproductive health remains a sensitive issue. Yet HIV/AIDS, early and unintended pregnancy, and illegal and unsafe abortion are widely recognized, by both young people and adults, as public health problems in need of intervention. A 1994 study found that most Zambian adolescents had limited knowledge about reproduction and sexuality and that 20.4 percent of childbearing, teenage women in urban Zambia were HIV positive. ¹ Although providing family planning information and services to adolescents is legal in Zambia, youth were routinely scolded by clinic staff who were reluctant to provide services to young, unmarried people. However, AIDS prevention clubs in primary schools and TV debates, sponsored by the World Health Organization and UNAIDS, have established high levels of AIDS awareness in Lusaka. The community is open to new approaches for reducing adolescent risk.

  Building Community Support

  In 1994, public health workers in Lusaka clinics realized that existing health care services were not reaching youth. Zambian NGOs further found that providing reproductive health information and education to adolescents did not encourage their use of health care services. Even though youth understood the importance of using health services, they were fearful of using them. The NGOs and clinics began to collaborate to identify and reduce barriers to young people's access to reproductive health services. The Ministry of Health (MOH) Maternal and Child Health/Family Planning unit launched an Adolescent Health Task Force. The Task Force was drafted to develop a National Health Programme for Youth, made up of YSOs and clinics.

  Recent policy reforms have decentralized health care in Zambia, making districts responsible for providing services to meet local needs. The MOH has established neighborhood health committees to provide a forum for communities to express concerns. The Lusaka District Health Management Team (DHMT) and UNICEF sought the collaboration of NGOs and health workers to establish what would soon become the Youth Friendly Health Services (YFHS) Project.

  The need to improve adolescent access to health services had been clearly established, but detailed data from youth themselves were lacking. The YFHS set out to learn why youth felt uncomfortable using health clinics and what youth needed to facilitate their use of health services.

  Developing a Plan of Action

  In 1995 the YFHS Project held three workshops designed to elicit information about the health-seeking behaviors of youth. Each workshop was attended by youth, health clinic staff, and NGO representatives. Following the workshops, YFHS held a strategic planning workshop, established an action plan, and formed a YFHS committee, led by the Family Life Movement of Zambia, to implement the plan. Part of the plan called for peer education at three clinics in Chilenje, Chawama, and Kalingalinga as a means of increasing clinic use.

  The YFHS committee held meetings with administrators in each district clinic to sensitize them to the idea of youth friendly services and to assess their willingness to participate in the project. Workshops were then held for administrators, clinic staff, and youth at the pilot sites to define "youth friendly services." At the workshops, participants laid out guidelines for the peer educators and developed ten standards for "youth friendly services." Fifty-two youth, ages 16 to 26 were trained to provide counseling, information, condoms, and referrals to their peers. The peer educators then conducted outreach in their communities to advertise the new program to youth.

  The programs provided adolescents entering a health center with the option of speaking with a peer educator or an adult community health worker. Should the client select the peer educator, they will meet privately. The peer educator will determine the nature of the complaint and consult the community health worker, who will decide on treatment. The peer educator then returns to the client to explain the needed treatment, bring medicines, and/or make referrals.

  Peer educators meet monthly with health clinic staff and representatives from the YFHS committee. In an effort to increase community support for the project, the peer educators, clinic staff, and representatives of neighborhood health committees also meet monthly.

  CARE: Improving Access to Services

  CARE International has taken a research-based approach to improving youth access to services in eight clinics it supports in Lusaka. In coordination with the Lusaka DHMT, neighborhood health committee representatives, and health clinic staff, CARE conducted research with adolescents using a participatory learning for action technique which encourages open discussion and allows participants to identify and analyze their own needs. The purpose of this research was two-fold: 1) to determine gaps in young people's knowledge about reproductive biology, sexuality, STDs, and pregnancy and; 2) to understand the treatment adolescents receive at health clinics and the types of services they would prefer to have available.

  CARE helped youth form 28 discussion groups at the clinics. The groups met periodically to develop health messages for their peers. Clinic staff also worked with the groups to educate other young people about available services and to improve relations between the clinics and youth.

  Institutionalizing Youth Services

  Plans are underway to expand YFHS to more Lusaka clinics, and the Lusaka DMHT is looking for ways to involve more youth in peer education roles. Since YFHS programs began in August 1996, the response from adolescents has been positive. The Ministry of Health has encountered encouragement, not resistance, from the community and clinic health workers in Lusaka. Although restrictive policies remain on making condoms available to adolescents at clinics, community health care workers are becoming much more flexible.

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  1 Fylkesnes K, Musonda RM, Kasumba K, et al. The HIV epidemic in Zambia: socio-demographic prevalence patterns and indications of trends among childbearing women. AIDS 1997; 11:339-345.