Serving the Reproductive Health Needs of Adolescents in Senegal

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Serving the Reproductive Health Needs of
Adolescents in Senegal

• Nafissatou J. Diop
• Conference on Youth and HIV/AIDS
• Tanzania, June 5-9

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Outline

• Background
• Community Interventions for Adolescents
• Who are the youth associations ?
• Consensus building between youth associations and
  the health district
• Capacity building of peer educators
• The life skills curriculum
• Impact
• Lessons Learned
• Scaling up

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Background

• Operation research conducted from 1999 to 2003
• To test the feasibility, the cost and the impact
  of a set of interventions
• in the community,
• in services and
• in schools
• This presentation will focus on youth community
  intervention

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Community Interventions for Adolescents

• Building upon existing organized youth
• associations in Sénégal
• Cultural and sports youth associations
• Development associations
• Others like scouts...
• Under the umbrella of the Ministry of Youth and
  its Direction of Youth and Life Associative and
  its decentralized services

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Who are the youth associations ?

• Well organized and juridical recognized
  associations ,
• established in the neighborhoods with different
  fields of activities
• Sport
• Leisures
• Education
• Community health
• Development, Income generating
• Utilization of this natural process to integrate
  adolescents reproductive health activities.

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Consensus building between youth associations and
the health district

• Selection of the most dynamic youth associations
  by the MOY, based on the mapping of the city
• Involvement of the youth organizations in the
  design of the intervention as part of a steering
  committee chair by the health district

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Consensus building between youth associations and
the health district

• Signature of a  faith based contract  between
  youth associations and the health district
• the president of the youth association commits
  its organization to provide peers educators and
  to ensure that they will work to reach the health
  district objectives on adolescents health
• the health district commits itself to provide
  equipment and technical assistance to peer
  educators, capacity building and funding of ARH
  activities

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Capacity building of peer educators

• Identification and selection of peers educators
  by each association following the criteria
  established by the local technical committee
• Supervision of selection by the Departemental
  Center for Popular and Sport Education and the
  Local Youth Council (MOY) staff
• Equipment (including income generating equipment)
• Training in 7 days one week real test 1 day
  feed back 4 weeks where they work by two (one
  young PE and an older one)
• Presentation of PE to the community in each
  neighborhood by the MOY and MOH staff

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The life skills curriculum Grandir en
Harmonie(developed by Hally Malher FHI)

• Dynamic approach, interactive and partipative
• Sketch, danse, corporal expression, music
• Education Entertainment
• IEC Animation
• Involve,
• Excite,
• Commit.

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Grandir en Harmonie eigth modules

• Lets know each other
• Values clarification
• Knowledge of the body
• Sexuality
• Reproduction and pregnancy
• Contraception
• STI/HIV/AIDS
• Responsible parenthood

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Conducting classes in the community level

• Coverage of the entire curriculum with the same
  group of 20 adolescents, meeting 2/3 times a week
• Certificate delivered to participants at the end
  of the curriculum
• Installation of life skills takes time
• Other mass activities for social mobilization
  (festivals, booth, concert, radio programming, )

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Impact
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Knowledge of Contraception
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Knowledge of contraception by method (All 10-19)
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Adolescents Approval of Contraception by
Non-Married Adolescents
Endline Exposed
Endline Non Exposed
Baseline
Louga
Males N B1349 E1235
Females N B1544 E 1503
10-14 years
15-19 years
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Sexually Active unmarried adolescents whose 1st
partner became a regularone (All 13-19)
P 0,022
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Sexual activity among unmarried adolescent during
the last 6 month
P 0,022
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Number of Sexual Partners Among Sexually Active
Unmarried Adolescents(All 13-19)
P 0,074
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Use of protection at last intercourse
P 0,007
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Use of Protection against Pregnancy or STIDuring
Most Recent IntercourseUnmarried Adolescents
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Knowledge and Use of Health Facilities
Males N B1,349 E1,235
Females N B1,544 E 1,503
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Lessons learned

• Improvement of knowledge and attitude
• Protection -
• Fidelity / abstinence
• No contraceptive methods
• Peer educator strategy worked for
• Social mobilization
• Education literate adolescents
• Preference for some modules

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Lessons learned

• Active and dynamic peer educators officially
  recognized by, and working with, other
  institutions in the area.
• Popular among the adolescent community
• Active in other health programs, i.e. malaria,
  AIDS, tuberculosis
• Solicited by development partners for their skills

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Lessons learned

• Need to involve different types of youth
  associations
• Development and income generating youth
  associations are more efficient for life skills
  activities
• Sport and leisures associations are more
  efficient in social mobilization and mass
  activities
• Signature of a confidence protocole between youth
  CBO and the health district
• Decrease drop out of peers educators
• Provide a carrer plan for peers educators

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Lessons learned

• Equipment to generate funds
• Way to motivate peer educators and maintain them
  in the program
• Allow to gain fund, but theres a need to
  organize the utilization of this fund to sustain
  ARH activities.
• Reinforcement of capacity of MOH to work with
  youth associations in order to reach their
  objectives
• Multisectoral collaboration is possible,
  effective
• Requires a coordinating body
• Requires a motivating structure

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In Conclusion

• Social Change Observed
• Increased demand for the program from
  communities, districts, other regions
• New confederation of peer educators in RH raise
  funds, maintain activities, active in health
  programs
• Multisectoral approach synergistic and supportive
  
• MOH priority plan of action for adolescents
• Projet Promotion des Jeunes/UNFPA strategic
  review
• Institution of a national coordinating committee
  for adolescent RH issues

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Scaling up

• The need to finalyse and developped tools
• Finalyse
• The life skills curriculum based on lessons
  learned and difficulties faced by peers
  educators.
• Development
• National strategy on adolescent health document
  developed in collaboration with WHO to orient
  region and district staff in Sénégal
• Facilitator guide
• Frequently asked questions

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Scaling up

• Other regions are replicating the model by
  integrating YARH into their annual plan of
  actions
• Specific groups of children in difficult
  situation and youth in danger was taken into
  account and the teaching approach of the
  curriculum Grandir en Harmonie was adopted.

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Scaling up

• Adoption of the curriculum by others Ministry
• Training of sports and popular education masters
  (Ministry of Sport) with the curriculum  Grandir
  en Harmonie 
• Use of the curriculum in school.

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Recommanded model

• Following WHO regional strategy for adolescents,
  public health facilities must be in the core of
  the system with bridges between them and the
  youth CBOs, the social services, the youth
  centers, the media, the training centers...

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Challenge

• Funding YARH activities
• - local funds at local level (regions)?
• - Partners ?
• - Government ?

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Thank for your attention