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Improving SRH & Reducing Gender Based Violence (GBV) Among Adolescents & Youth

Project Profile. Public Health Concern Trust (PHECT) began executing and implementing the RHIYA Nepal in September 2003, in Bhimeswor municipality & 4 Dolakha peripheral VDC.
PHECT targeted especially both in & out of school A/Y aged 10-24, to improve their SRH practices / behavior, enhance utilization of SRH services by them and reduce GBV in the target areas. It reached about 24,000 A/Y. PHECT also targeted parents / families, school teachers, health service providers and other community members & stakeholders such as members of youth clubs, community leaders, FCHVs, volunteers and CBOs from the project area on a secondary basis. A/Y and communities were empowered with ASRH knowledge & skills enabling them to take care of their health.
PHECT Nepal indeed aimed to create a model of sustainable health care system based on the principles of equity, social justice, people’s participation and self reliance in the target areas. It sought to address SRH concerns from medical, social, legal and psychological perspectives, as well as all forms of discrimination affecting SRH.
During the 33 months of the project period, particular emphasis was given to ensure the confidentiality, respect & user friendliness of the services offered. This approach enabled the program to gain the trust and respect of the community and to talk on sensitive issues.

Strategy. With almost no organization / program focusing on SRH in Dolakha district in the past, the communities & A/Y lack awareness on SRH and gender issues and face problems such as STI/HIV/AIDS, gender discrimination, early marriage, teenage pregnancy, alcoholism often resulting into violence, etc. Similarly, the selected VDC are predominantly inhabited by underserved, underprivileged and marginalized ethnic groups.
The strategy of the project was based on implementing interventions consistent with national policies so as to supplement/complement existing programs. The project also focused on strengthening linkages & collaboration with the GoN, CBOs/NGOs, RHIYA partners and encouraging community participation and local initiatives for sustainability of the program.
Involvement of A/Y and community people in all stages of the project was important to ensure appropriate planning of interventions and that the real needs of A/Y would be properly addressed. Linkage within and outside RHIYA is also important. The program trained peer educators (PE) / youth educators on ASRH & GBV issues to get to A/Y, and youth clubs were mobilized to be youth information center (YIC). Considering the need to strengthen and sustain YIC, some were added during the implementation phase and certain amount of unspent money was used to run YIC’s activities. In addition, specific health / life skill education package was introduced in schools to improve ASRH education, and teachers were trained jointly with District Education Office (DEO) and teachers' associations.
To implement the project, PHECT opened a field-office with a youth friendly service delivery (YFSDP) in Dolakha based on its past experience in establishing a center for community based RH care & counseling center (CBRHCC). The CBRHCC functioned as model counseling/ training center and its team of experts (physician, psychologist, lawyer...) made monthly visits to Dolakha, to guide, supervise and assist the field-office & other staff in carrying their tasks and providing special services to the clients / people as needed.

Outputs.
1) Increased political, community support for ASRH interventions: The 91 planning & coordination meetings conducted with stakeholders such as district health system providers, NGOs, CBOs (youth clubs, VDC, municipality), parents, guardians & A/Y helped to establish linkages / partnership. In consultation with community & youth clubs, 15 advisory / support group committees were formed to support the program interventions / value implementation. 3306 community stakeholders & 659 local political leaders were sensitized on ARSH & GBV issues through 203 advocacy activities jointly held with NGOs, CBOs, community leaders, FCHVs, support groups & A/Y, and increased their knowledge on early / unwanted pregnancy, abortion, sexual behaviors, girls trafficking, STI, HIV/AIDS, drug...Among these activities, 39 were held during events like World AIDS Day, Violence against Women Day…etc. to give the project more exposure. Participants were thus informed and encouraged to develop healthy behaviors. Moreover, strong support was received from health related departments, ministries and NGOs for the development of ASRH & Gender sensitization Counseling Reader’s & Trainer’s Manuals, GBV flipchart and TOT Counseling Training.

2) Increased awareness & SRH and GBV knowledge among A/Y: 21,247 copies of various types of ASRH, gender and general health IEC materials including newsletter were distributed to A/Y through YFSD/YIC, PE and staff to increase their ASRH / GBV related knowledge. Also, 1569 A/Y community sensitization activities were conducted during the project, wherein 1,35,522 A/Y (66,351 M, 69,171 F) were benefited through various ways such as A/Y workshops / sessions, street drama, video shows, health education classes, rally, quiz contest, etc. PE had 103,880 A/Y (52,588 M, 51,392 F) contacts for STI, SRH, GBV and others. 1000 GBV wall charts / posters and 400 pieces of promotional material like bags were distributed to the PE to advocate for RHIYA activities. They also performed 25 street dramas on ASRH / gender issues during national and international events, which is a useful mass dissemination tool. The 50 episodes of the radio program “Hamro RHIYA club” provided by UPSU also helped to further increase A/Y knowledge on the issues.

3) Improved access to quality youth oriented SRH services: Project provided quality clinical & non-clinical services to A/Y and adults through 10YIC & 1YFSD. 51,210 A/Y benefited from knowledge on SRH, life skill, HIV/AIDS, GBV and girls trafficking & l6, 358 condoms were distributed in YFSD &YIC. One of the major activities was to identify & provide services to GBV clients: owing to multidisciplinary experienced staff, the YFSD identified 185 GBV cases out of 808 A/Y screened. It received 10, 042 clients in total. The capacity building of health facility staff, government / PHECT staff, A/Y, teachers, PE and Youth Club (YC) members through various trainings, workshops and refresher trainings such as on infection prevention management, helped to recognize SRH & gender related problems and increase the use of services by influencing health behaviors. YIC, YFSD, PE and staff were focal points for provision of ASRH IEC material and also for referral services to higher health facilities as per identified needs (719 cases were referred). The quality of services was also ensured through the development of YIC & YFSD guidelines, ASRH & gender sensitization counseling readers/ trainer’s manuals and GBV flip chart as resource materials.

4) Enhanced technical, planning & managerial capacity among GoN, NGO,CBOs in the provision of ASRH information &service: Project staff and volunteers participated in trainings, workshops, seminars organized by GO & (I) NGOs to strengthen their capacities, get knowledge and share it in the forums: A total 757 staff / volunteers, teachers, govt. health service providers were trained on various types of trainings like ASRH & gender sensitization counseling TOT (received by the 7 RHIYA partners), life skill based PE trainings, YFSD training, infection prevention training, street drama training…etc. Refresher trainings were also organized jointly with RHIYA partners as per areas of expertise, such as on ASRH & gender sensitization counseling for GoN health facilitator & PE. Moreover, regular field visits for supervision, monitoring & backstopping by / from central level staff (or by / from UPSU for management, financial, admin issues) further helped to improve the capacities of staff. Also, international exchange visit in Cambodia by 3 senior project staff allowed observing and studying the activities there and learning from it.

Lessons learned. Linkage & collaboration outside and inside RHIYA program is essential to succeed. Proper orientation about the program and explication of the priority towards public health problems helps to raise support from communities, even voluntarily. Involving stakeholders (PE, GoN health staff, youth clubs, CBOs and communities) and target groups at different stage of the program is very important for mutual trust and commitment to the program for provision of quality SRH services in the short term & sustainability of the project in the long run. However, maintaining neutrality especially in carrying out field works is very crucial, but more in the context of conflict situation. Partnership with RHIYA partners &UPSU provided allowed sharing experiences, learning from each other's best practices / mistakes, and also for the development of manuals/guidelines and other IEC materials.

ASRH services & information: Trainings/capacity building itself is not sufficient to disseminate information & services including for minimizing the violence of sexual assaults, improving SRH behavior in the communities and to sustain the progresses. Service providers with friendly behavior & skills and post training monitoring, supervision and feedbacks are even more important. Sensitiveness of ASRH & GBV related issues demand collaborative efforts of parents, opinion leaders and teachers to create a supportive environment for effective delivery of SRH & GBV services. Good methods for quality of services were screening for GBV cases and inclusion of psychosocial & legal counseling to deal with GBV.

ASRH material and locations: YIC & YFSD are very much necessary as A/Y feel comfortable in receiving services / counseling through next door while coming there to read or play games in eyes of their parent. Efforts should be given on creating IEC materials that are of edutainment nature in the form of games, role plays, drama, etc and their increased use in programs as AY are more likely to prefer such materials. Pictorial nature of IEC materials is equally useful in disseminating messages to illiterate AY. The YIC management committee members & PE will continue meeting and awareness activities previously run by the YIC in the existing youth clubs premises. The YIC which exist in Govt health facilities will remain and will conduct through PHC/Sub health post management committee.

Partner profile. Public Health Concern Trust (PHECT) was established in Kathmandu in 1991, with the aim to create a non-governmental, non-commercial model of a sustainable health care system, based on the principles of community participation & ownership, self-reliance & empowerment of people, and which could be replicated by other organizations. PHECT provides quality preventive and curative services at the Kathmandu Model Hospital, and through a network of Health Information & Service Centres (HISC) and outreach activities in 9 VDCs. Services are free of charge for people who cannot afford to pay PHECT’s mission is to recognize that health is the individual's ability to achieve, enjoy and maintain a harmonious relationship with his/her self and with nature at large; it the vision of "empowerment of people through health action."

Contact: Public Health Concern Trust, Nepal Bagbazar Kathmandu Nepal Tel/Fax: +4222450, +4256917