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Promoting Services in the Community
Youth reproductive health programs have mounted a variety of activities to promote services at the community level. Common approaches include (11, 23):
- Having health workers give public talks in the community,
- Meeting with influential community members to raise their awareness of youth reproductive health needs and seek their support for integrated services,
- Training community members, including peer educators, church members, and, sympathetic adults, to discuss a range of reproductive health issues with young people and, when appropriate, make referrals to local facilities (see box on Kenya, p. 19); and
- Publicizing the integrated services available for young people on billboards and posters, in newspapers and magazines, on the radio, and at community gatherings.
Community activities help to overcome the fact that, despite efforts to improve the quality and youth-friendliness of services, many reproductive health programs have not been able to attract more young clients (42). According to a review by WHO, training providers and making services youth-friendly are not enough to increase young people’s use of family planning and HIV/AIDS services. Programs also must do more to promote services in the community to young people and to involve the opinion leaders and gatekeepers who influence access to services (11).
Going outside the clinic to promote services in the community serves two key purposes that together can help programs meet the integrated health needs of more young people. First, a community approach can make people better aware that youth-friendly services are available at nearby health facilities and that these integrated services address a range of needs, including family planning and HIV counseling and testing.
Second, engaging the support of parents, neighbors, teachers, religious leaders, peers, and other influential community members, can positively influence young people’s beliefs and behaviors about their own reproductive health. Adults in the community often act as gatekeepers, with the power either to reduce or to increase young people’s access to reproductive health information and care.Young people are more likely to seek care when parents and other adults actively support the provision of services and even act as mentors on reproductive health issues (21, 22, 46). Peer educators also have proven effective in connecting youth with services (1).
The tools described in this section can help program managers to design and implement community-based activities that encourage youth to seek integrated services. First, however, managers must determine which types of activities make the most sense for their program.The following questions can help managers decide which activities are likely to have the greatest impact on use of services.
- What is the purpose of promoting services—for example, to advertise integrated and youth-friendly services, build community support for reproductive health care for young people, counsel youth on adolescent health risks, or some combination?
- Which members of the community have the greatest influence on young people’s access to different kinds of reproductive health services?
- Which members of the community have the greatest potential to influence young people’s attitudes and behaviors regarding reproductive health?
- What are the most effective and efficient ways to reach key people in the community?
Community promotion tools. Each of the tools in this section offers guidance on a specific type of community-based activity, including:
- Advocacy, which demonstrates young peoples’ need for family planning, STI, and HIV/AIDS information and services to community leaders and the public,
- Participatory assessments, which can train people to collect information on reproductive health from their own communities, analyze and share the results, and make recommendations regarding project activities,
- Peer education, which can train young people to offer integrated reproductive health counseling, including information and referrals, to their peers, and
- Faith-based counseling, which trains adults to lead discussions of reproductive health challenges and associated religious teachings with young people.
All of the tools are tailored specifically for youth reproductive health programs.
Penn, A. Advocating for adolescent reproductive health in Eastern Europe and Central Asia. Washington, D.C., Advocates for Youth, 2004.
Shannon, A. Advocating for adolescent reproductive health in Sub-Saharan Africa. Washington, D.C., Advocates for Youth, 1998.
These advocacy kits describe how to develop, implement, and evaluate a successful advocacy strategy in two different regions of the world. Case studies from each region illustrate the guidance provided on setting goals, building networks, involving young people, mobilizing the public, gaining the support of community leaders, and responding to opposition and criticism.The kits also include a section on responding to commonly asked questions about adolescent reproductive health.
Available at:
Eastern Europe and Central Asia:
PDF: http://www.advocatesforyouth.org/publications/advocate_eeca.pdf
Sub-Saharan Africa:
HTML: http://www.advocatesforyouth.org/publications/advocate/
PDF: http://www.advocatesforyouth.org/publications/advocate.pdf
en français—Un plaidoyer pour la santé reproductive des adolescents en Afrique Subsaharienne
PDF: http://www.advocatesforyouth.org/publications/advocate_fr.pdf
For print copies: Publications Department, Advocates for Youth, 2000 M Street NW, Suite 750, Washington, D.C. 20036.Tel: 202-419-3420. Fax: 202-419-1448. E-mail: information@advocatesforyouth.org.
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Kenya: Training Community Members to Counsel Young People
Following traditional Kikuyu approaches to counseling young people, the Nyeri Youth Health project in Kenya trained 25 respected young parents to serve as “Friends of Youth” in their own communities. These mentors met weekly with youth groups based in schools, churches, and sports clubs to discuss reproductive health and encourage safe behaviors, including delaying sexual debut, adopting secondary abstinence, and reducing the number of sexual partners. When individual youths needed reproductive health care, the Friends of Youth referred them to youth-friendly doctors and pharmacists and gave them a coupon for subsidized services. Friends of Youth also worked with teachers, parents, and other adults to encourage a supportive climate in the community.
An evaluation found that the Nyeri Youth Health project reduced risk-taking behaviors in participating com-munities. Compared with peers at control sites that did not recruit or train Friends of Youth, sexually experi-enced girls in project sites were over three times as likely to have abstained from sex for the last six months and one-tenth as likely to have had three or more sexual partners during the previous three years. Boys in project sites were almost four times as likely to have used a condom at last sex as those at control sites.
Referrals made by the Friends of Youth also spurred the use of health care services by young people. Over a three-year period, more than 2,700 young people visited participating providers, mostly for reproductive tract infections, family planning, and male circumcision.
Source: Erulkar et al. 2004
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Zambezi, R. and Hernandez, J.J. Engaging communities in youth reproductive health and HIV projects: A guide to participatory assessments. Arlington, VA, Family Health International, 2006.
This guide describes how to conduct participatory assessments that can involve community members (including young people) in projects to improve youth reproductive health, for example, by reducing HIV transmission. It distills the experience of the YouthNet project in Namibia,Tanzania, and Ethiopia, where the project trained young people and adults to facilitate assessments of youth reproductive health, make recommendations for action by the government or by faith-based groups, and help implement those recommendations.The publication offers a series of easy-to-follow guidelines and a simple toolkit for Participatory Learning and Action (PLA) activities.
Available at: http://www.fhi.org/en/Youth/YouthNet/Publications/CIresources/index.htm
PDF: http://tinyurl.com/32hhcl
For print copies: Family Health International,YouthNet Program, 2101 Wilson Blvd, Suite 700, Arlington,VA 22201 USA.Tel: 703-516-9779. Fax: 703-516-9781. E-mail: youthnetpubs@fhi.org.
International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR). Peer to peer: Creating successful peer education programs. New York, IPPF/WHR, 2004.
This guide describes the practical steps involved in planning a peer education program, selecting and training youth educators, implementing and supervising peer education activities, and monitoring and evaluating the program. Each section includes sample tools, additional references, and examples of peer education projects in Latin America and the Caribbean.The contents are based on a bibliographic review of peer education programs and a meeting of experts on the reproductive health of young people drawn from organizations throughout the Americas.
Available at: http://www.ippfwhr.org/publications/publication_detail_e.asp?PubID=62
PDF (English): http://www.ippfwhr.org/publications/download/monographs/PeertoPeer_E.pdf
PDF (Spanish): http://www.ippfwhr.org/publications/download/monographs/PeertoPeer_S.pdf
For print copies: IPPF/WHR, 120 Wall Street, 9th floor, New York, NY 10005.Tel: 212-248-6400. Fax: 212-248-4221. E-mail: info@ippfwhr.org.
Youth Peer Education Network (Y-PEER), United Nations Population Fund (UNFPA), and Family Health International/YouthNet. Youth peer education toolkit: The training of trainers manual. New York, UNFPA, 2005.
This manual reviews the rationale for and value of youth peer education, presents a curriculum and handouts for a six-day training-of-trainers workshop, and gives an example of a peer education session on HIV/AIDS. It is based on both research and field experience.The manual forms part of a larger Youth Peer Education Toolkit, which includes standards for peer education programs, quality assessment and performance improvement tools, and a manual for theater-based techniques for peer education.
Available at: http://www.fhi.org/en/Youth/YouthNet/Publications/peeredtoolkit/index.htm
For print copies: Family Health International,YouthNet Program, 2101 Wilson Blvd, Suite 700, Arlington,VA 22201 USA. Tel: 703-516-9779. Fax: 703-516-9781. E-mail: youthnetpubs@fhi.org.
Family Health International/YouthNet. Family life education: Teaching adults to communicate with youth from a Christian perspective. Arlington, VA, FHI, 2006.
Family Health International/YouthNet. Family life education: Teaching adults to communicate with youth from a Muslim perspective. Arlington, VA, FHI, 2006.
These two training manuals and accompanying participant handbooks are designed to help adult participants clarify their religious values around sexuality, reproductive health, and HIV and to open a dialogue about reproductive health and religious teachings with young people. During a series of six workshops, participants learn about adolescent development, prevention of STIs and HIV, unintended sex and alcohol and drug use, marriage and family planning, communicating with young people, and referring youth to clinical resources.
Available at: http://www.fhi.org/en/Youth/YouthNet/Publications/FLE/index.htm
Limited print copies available. For information, please contact: Family Health International,YouthNet Program, 2101 Wilson Blvd, Suite 700, Arlington,VA 22201 USA.Tel: 703-516-9779. Fax: 703-516-9781. E-mail: youthnetpubs@fhi.org.
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