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Addressing Young People's SRH Needs - Tomorrow's Parents

Project profile: From April 2004 to December 2006, Marie Stopes Society (MSS) implemented the RHIYA Pakistan within disadvantaged & poor districts of Kohat & Jacobabad, which are communities of remote and neglected parts of country. MSS’ objective was to improve SRH and overall well being of vulnerable A/Y aged 14-24 as the main target group. MSS also aimed to contribute increasing utilization of quality youth friendly and gender sensitive ARH services and improved RH behaviour among A/Y, including girls who are restricted in their mobility because of the cultural/traditional context.

The biggest success of MSS was thus the social acceptance of ARH as an issue by all stakeholders in a conservative society such as Pakistan. Influential stakeholders, community elders (parents, teachers, religious leaders…) and health service providers were provided with regular training programs on ASRH, making them the second beneficiary group of the project. MSS overcame all challenges through centring its efforts in consulting influential stakeholders.

Strategy: Addressing the local needs is at the heart of MSS programmes. To succeed in its tasks towards the RHIYA, MSS used an integrated approach especially focusing on networking with key gatekeepers such as parents, teachers, community/religious leaders and health service providers which allowed winning their confidence, providing them training, developing advisory groups and establishing a real Community Advocacy Network (CAN). MSS also recruited, trained and involved youth peer leaders, peer groups and volunteers so as to create a Youth Advocacy Network (YAN). CAN and YAN were involved in implementing/ organizing the activities designed by MSS to improve mobilization and ownership of the programme at the community level. However, the project’s design did not follow a rigid approach: partners were allowed to undertake more adapted activities depending on the districts or communities.

In addition, MSS realized an intensive mapping exercise to identify locations for establishing 30 YFC (20 in Jacobabad and 10 in Kohat) where a maximum of A/Y could utilize and benefit services ranging from quality ARH information and counselling and training to edutainment material respectful of the target communities. MSS took a lead role in developing counselling and referrals packages in Pakistan. MSS also adopted some more innovative approaches to address the ARH needs of young people like outreach activities called “neighbourhoods meetings”, arranged by local volunteers and people living nearby, and school & Madrassas (religious schools) corners, which helped to provide further RH information and services under the consent of influential gatekeepers.

Outputs: 1) Stakeholders support for ARH interventions: In order to reach this goal, MSS focused on mobilizing local community members. Youth Advocacy Committees and Technical Advisory Groups (TAG) comprising key community members with a public or private sector network were thus formed, to raise support of the community, but also to guide and assist the implementation of activities. However, the most effective model has been extensive consultations with local religious scholars & Mullahs since their support generated confidence and encouraged community members’ participation. A total of 15,081 community members received ARH information. MSS also developed linkages with at district & national government levels which resulted respectively in the incorporation of ARH issues in district level plans & budget and the development of a “National Youth Advisory Group for Population & Development” formed by the Ministry of Population Welfare.

2) Improved awareness & SRH knowledge among A/Y: MSS used a number of tools to reach this goal, ranging from school awareness campaigns, ARH awareness sessions at YFCs and message dissemination through sports, cultural events, debate sessions & dialogue forums between A/Y, parents, teachers & other stakeholders organized by the PE recruited (600 in Jacobabad; 300 in Kohat). However the main achievement of MSS has been to break the taboo / silence on issues such as Family Planning, teenage pregnancies, rape, Karokari (honour killings), masturbation, homo / heterosexual activities through a wide use of IEC material and by organizing edutainment activities such street theatre that educated both male and female youth but also helped GoP institutions and gatekeepers to take conscience of it.

3) Increased access to youth oriented SRH services among A/Y: MSS offered youth friendly, confidential and affordable services such as counselling, referral, contraception and STI management. These services were provided at the YFCs, wherein recreational activities and life skills education like computer training were made available to attract a maximum of A/Y. They were 1548 youths visiting YICs in 2004 and 6771 in 2006. However due to a lack of clinical services under the project and a lack of facilities in GoP hospitals, MSS initiated referrals to local private ASRH service providers for test, treatment & follow up. In addition, medical camps were held with the help of UNFPA Mobile Service Unit, district population department & an NGO and medical doctors and counsellors were trained on youth friendly service delivery (YFSD).

4) Technical, planning & managerial capacity building strengthened: In order to provide quality and standardized RH information and services, MSS developed some Master Training tools consisting of ARH training-learning packages, counselling & communication package and advocacy packages. These served ad reference materials for all gatekeepers including PE, teachers and others such as government & local NGO/CBOs to ensure a successful implementation of the project and its sustainability beyond the RHIYA. Moreover, capacity building measures and instruments were given to the district project teams such as the M&E, KMS and financial management system or EMAP (Evaluation, Monitoring, Assessment and Planning) system to monitor RHIYA activities and give recommendations for improvement.

Lessons learned: Involving government and public institutions can be beneficial to ensure the successful implementation of the project and achievement of objectives. It greatly enhanced the trust, confidence and interest of people in the project which resulted in a viable environment for promoting RHIYA agenda further. As a result Jacobabad district’s YFCs were registered as Citizen Community Boards (a government recognized entity) allowing the YICs to get yearly resources from the GoP to implement local development plans. Collaboration with religious leaders was also helpful to appease doubts and myths related to RH, and overcome the community suspicion regarding NGOs.

SRH education and services: Outreach activities should be emphasised to reach A/Y who cannot visit the YFCs regularly. Youth require more recreational opportunities and facilities to best utilize their spare time. Street theatre to raise awareness and disseminate information was recognized as a good BCC tool. Concerning sustainability of the services in the target districts, MSS will convert its 19 best performing YFC into YAN, CAN, CCBs and NGOs/CBOs to be used twice a month to provide counseling and camp services by MSS Doctors, Paramedical staff and Counsellors. MSS will also strengthen its Sukkur & Peshawar Training Centres to build the capacity of staff, meet the organization’s medical protocols.

Comprehensive Information on intervention areas: As a principle, it is important to be well cognizant of the customs, traditions and political atmosphere of the project intervention area in order to design flawless and relevant strategies for implementation.

Partner Profile: Marie Stopes Society (MSS) was registered in 1990 as a non-profit, non-governmental organization (NGO) to provide reproductive health services with a development perspective. Beginning with one centre in 1992, today MSS has expanded to more than 100 information and service delivery centres across the four provinces of Pakistan. Established as a unique social business organization, applying modern marketing and management techniques to the achievement of social ends and contributing towards national poverty reduction, MSS services are accessible to approximately 40 million people of the country. Under the RHIYA, MSS establish 30 Youth Friendly Centers aiming at sensitizing the communities on ARH issues, communicating and interacting with youths, and provide quality counselling.