Youth in front of Marie Stopes entrance - © Mozaharul Islan Khan

Better SRH services for urban adolescents and youth

Project profile. MSCS worked jointly with Nari Maitree (NM) which supported MSCS in delivering the outputs. MSCS was leading the output 3 among RHIYA partners (”Increased availability of quality, culturally and gender sensitive SRH education, counseling and services for youth”) and implemented the project in 5 districts of Bangladesh-Dhaka, Mymensingh, Tongi, Narshindi & Moulvi Bazar. It focused on the overall development of the SRH status of young people through awareness building, improving knowledge, changing attitudes & skill development. The project included facility based activities (establishment of youth clubs which acted as a resource and development centers) & community based activities (meetings with parents/guardians/gatekeepers and local advocacy meetings with other stakeholders).
MSCS participated in agreeing on youth friendly spaces used by RHIYA partners in line with service protocols established at Government level. A range of counseling and clinical services were set up and also benefited from referrals from other RHIYA partners. The project also focused on peer networking and a media campaign with electronic media coverage to increase awareness and advocate to young people in project areas. Marie Stopes is one of the founder of NEARS (Network for Ensuring Adolescent Reproductive Rights and Services). It also actively participated in all the initiatives of UPSU such as the Counseling Package, Reporting system development, MIS package, helping in organizing special events.

Strategy. 1) MSCS project was designed on empirical evidences, experiences of organizations working with the projects and on practical needs of the communities, focusing on underserved and poor A/Y. It was also inline with the priorities of the government of Bangladesh: adolescents have fewer contacts with the healthcare system compared to other age groups, regardless of their needs for specific services; low knowledge about HIV/AIDS transmission compared to A/Y from other developing countries (UNAIDS strudy); use of contraception increases among married adolescents but needs unmet; higher death rate among girls compared to boys aged 15-19 years mainly due to maternal causes; high risk factors (STIs prevalence, intravenal drug use, poverty, commercial sex industry...) and HIV/AIDS situation in India and Thailand predisposes Bangladesh for a HIV/AIDS crisis; cultural differences, conservativeness and individual attitude.

2) MSCS’s strategy was built on RHIYA outputs:
-Establish deep rapport and trust with communities through community meeting, special workshop on ARSH issues, civil society workshop & youth fair; sensitize religious leader towards ASRH through orientation on ARSH issues and provide information on A/Y needs.
-Equip adolescents with appropriate knowledge and life skills for addressing the SRH needs and concerns : provide community activities, BCC materials and healthy behaviour in day-to-day life; improve A/Y decision-making negotiation skills through training; establish resource centres as knowledge development centres; enable people to talk about SRH issues.
-Improve access to quality adolescent oriented counselling and clinical SRH services: enable youth friendly services, privacy, confidentiality, and counselling for adolescents from service provider through training and motivation.
- Increase support among community gatekeepers and policy makers about SRH needs of adolescents: ensure advocacy meetings, active participation of community stakeholders; develop strong networking of NGOs working on A/Y to help to create an environment forA/Y; develop community based resource centres for ownership and empower A/Y to disseminate information and to take decision; dependency on external funding is crucial for this project and also short period funding; establish demand for AFHS.

Outputs. MS’s main outputs were: (October 2003 – June 2006)

1) Enabling environment created and youth related policies formulated and institutionalized for provision of SRH information, including support from community gatekeepers, parents and guardians: community members were more supportive and involved in the program, sending their children for information/ services. In total there were 28,320 participants to 1,107 advocacy events (meetings, rallies and fairs) jointly organized with RHIYA partners, government officials and other NGOs in favor of ASRH information and services gradually increased. 2 TV spots were developed for national channels.

2) A/Y are equipped with appropriate knowledge, life skills for addressing their SRH needs and concerns: young people were informed through 4,220 health education session, video sessions, peer education sessions, life skill training & media campaign. 364 peers received training on life skills (family planning, gender, STI/ HIV/AIDS, safe motherhood, nutrition, hygiene, drug, early marriage etc). 30,824 young people participated in 5,903 peer education sessions in all the RHIYA (SDPs). 19,409 BCC materials were distributed.

3) Increased availability of quality, culturally and gender sensitive SRH education, counselling and services for youth: MS developed a manual called ‘Quality of services at service delivery points’ conducted with MAMTA, India. 23 NGOs staff received training on it. To assess access and client satisfaction following tools were introduced in SDPs : complain register allowed to take necessary action; 447 client exit interviews were conducted; mood meter box was introduced for illiterate clients to express their opinion; a telephone hotline. 90% A/Y satisfied with the young people friendly services. 147 RHIYA staff received training. BCC material, QoC manual, Counseling package, gender manual developed jointly by UPSU and partner NGOs. 46,685 clients received services through 7 SDPs of MS& NM and there were 20,790 new clients. 34,237 young people were referred for services.

4 ) Capacity of NGOs developed to provide youth friendly quality clinical SRH services through a variety of outlets/ means: 147 RHIYA staffs and 364 peers were trained; 55, 938 A/Y peers received orientation on ASRH. MS arranged and attended several meetings with RHIYA staff to see the progresses and exchange visits for peer educators and RHIYA staffs to share experiences. MS conducted a quality research on "Perception of A/Y on quality of SRH services” awarded to Capacity Building Service Group (CBSG), a consultant organization. MS provided training to 23 doctors of RHIYA partner NGOs, participated in a sustainability workshop arranged by FPAB and conducted by MAMTA. Young people received youth friendly services from RHIYA clinics and more awareness developed on ARSH issues.

Lessons learned. Peer Education approach is a sustainable way of reaching and increasing awareness of young people on RH and realted issues. Peer educators’ activities were hard to monitor; collection of information and monitoring the activities at the community level was difficult. Should have a mechanism for monitoring how peer education approach works in the community. Peers often lost their commitment and interest, as they did not get any incentive allowance of their work.

ASRH: Youth friendly behaviour in delivery services can increase the acceptance of the project in the community. Access to the information and health services has increased tremendously because of the project. Turn out of patients is not enough to have separate clinic for young people. Reporting of family planning method distribution to the unmarried is a problem. 10-19 year’s age groups are very sensitive and difficult to deal with and should be handled with very caution. People out of the 10-24 age group though they were deprived.

Dissemination of information: educate all stakeholders is an important tool for increasing awareness and acceptability since antagonist and ignorant people can be brought in favour of the project if properly informed of the goal and objectives of the project. Gatekeepers, including religious leaders was much more open due to motivation or orientation first that makes the work easier. Providing life skill training and livelihood training is not possible without external financial support. The project was not any long-term plan and as such no foreseeable mechanism to sustain. Political unrest is a challenge as it involves the need to reschedule project activities implementation. Project had to be shaped by the socio-economical, socio religious and socio-political and community roles and responsibilities in the respective working areas.

Partner profile. Marie Stopes Clinic Society was established in 1988 with a modest centre in Chittagong. Since then, it has grown and developed tremendously and is now a key provider of high-quality RH services (community based and outreach) to the poor in Bangladesh such as family planning and contraceptive services; ante and post-natal care; female sterilization; vasectomy; primary health care; the prevention, diagnosis and treatment of STIs; STI/HIV/AIDS awareness-raising initiatives). Funding for activities comes from a wide range of sources, reflecting MSCS’s good reputation (DFID, EU/UNFPA, the Asia Development Bank/Government of Bangladesh, and private sector). Marie Stopes in Bangladesh, carried out ASRH project since November 1999 and was funded through EC/UNFPA. The first phase of the project ended in December 2002. Considering the experience gained by Marie Stopes in the first phase, UNFPA further funded Marie Stopes to proceed in the second phase (RHIYA) in October 2003.

Contact: Marie Stopes Clinic Society House #6/2, Block F Lalmatia Housing Estate Dhaka - 1209 Bangladesh Tel: Fax: