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Scaling Up AYSRH Programs: Increasing Impact Without Affecting Quality

Recap of Connecting Conversations Theme 5, Session 3

On November 11, Knowledge SUCCESS and FP2030 hosted the third session in our final set of conversations in the Connecting Conversations series. In this session, speakers discussed key considerations for scaling up effective and evidence-based AYSRH programs to ensure that impact is far-reaching across youth populations and geographies.

Missed this session? Read the summary below or access the recordings (in English or French).

Featured Speakers:

  • Adenike Esiet, executive director, Action Health Incorporated.
  • Brendan Hayes, senior health specialist, Global Financing Facility.
  • Dr. Galina Lesco, head of National Resource Centre for Youth-Friendly Health Services, NEOVITA Health for Youth Association.
  • Laura Ghiron, member, ExpandNet Secretariat, president, Partners in Expanding Health Quality and Access (moderator).
Clockwise from left: Laura Ghiron (moderator), Dr. Galina Lesco, Brendan Hayes, Adenike Esiet.
Clockwise from left: Laura Ghiron (moderator), Dr. Galina Lesco, Brendan Hayes, Adenike Esiet.

What do you think are necessary components or activities for effectively scaling up AYSRH programs?

Watch now: 17:15

Panelists spoke about the importance of strong legal and governmental frameworks to support programming. Adenike Esiet shared her experiences providing a comprehensive sexual education curriculum in Nigeria. She described several key areas that were critical to effective program implementation: national policy frameworks, evaluation mechanisms, access to curriculum development and classroom resources, and extensive training for those delivering the curriculum to students. She also emphasized the importance of evaluating potential intervention points and designing the program with these in mind.

“One of the key things to do when scaling up a program is to look at the different key component areas of how the program would be implemented at a smaller scale.”

Adenike Esiet

Dr. Galina Lesco highlighted the necessity for interventions to be evidence-based. She also built on Ms. Esiet’s earlier point that programming requires a supportive legal framework, sustainable financing mechanism, quality control system, and promotion to the relevant population. Brendan Hayes spoke about the need to ensure sustainable financing when scaling up AYSRH programming. He described how the majority of innovation regarding financing has occurred outside of the governmental sphere, but emphasized that governmental stakeholders should have a more robust role in financing these programs. Mr. Hayes also suggested that utilizing local and national governments could be instrumental in ensuring that programs deliver interventions that are free at the point of care.

What are some of the challenges that you’ve encountered when implementing and scaling up AYSRH programs? How have you been able to transcend those challenges?

Watch now: 29:17

Ms. Esiet discussed the need for policies to be in place to support the implementation of AYSRH programming. She provided the example of how advocacy efforts surrounding AYSRH in Nigeria had been occurring for nearly a decade, but were struggling to fully reach youth due to funding constraints and a lack of governmental support. However, when the AIDS epidemic hit the region, governmental officials decided to enact policies that would finally support the AYSRH work that was already being performed. She also discussed the specific challenges faced within her sexuality education program. Some of these issues included training teachers who did not have a background in sexuality education, taking teachers out of the classroom in order to provide this training, and tailoring the teacher training to address not only curriculum content, but also their internal biases and personal values.

“Even when we had a good program that was ready to be scaled up, we encountered systemic challenges.”

Adenike Esiet

Mr. Hayes described how in many instances, the pilot stage does not involve the rollout of a perfectly designed intervention, but requires consistent refining and reevaluating. He emphasized that challenges are inevitable, yet unpredictable in their nature; for this reason, programs need to be adaptive. Dr. Lesco discussed how programming in Moldova is often difficult due to limited financial resources. She described the need for constant monitoring and data collection on program effectiveness, as this data is presented to governmental agencies in order to have programs included in the national budget. She also highlighted the necessity of this data for advocacy efforts and securing funding from international donors.

“We often have this idea that in the pilot phase, we are incubating the perfect intervention that we will then bring to scale; in reality, most of our experiences in scaling programs involve lots of bits and starts, and are full of things that went wrong and had to be retooled.”

Brendan Hayes

How does stakeholder engagement factor into scaling up AYSRH programs? What is the role of youth within this engagement process?

Watch now: 42:45

Dr. Lesco spoke about the importance of involving youth in all steps of program design and implementation. She discussed how her program makes an effort to engage youth in planning/organization, program evaluation, implementation (in the form of volunteering), and in promotion of services to the community. In regards to other key stakeholders that need to be engaged, Dr. Lesco discussed the need to secure support from state authorities at the beginning of the program design stages and to sustain their involvement throughout the implementation process. She also mentioned the need to involve professional associations and educational institutions, as she emphasized that consistent curriculum revision for health professionals is critical to ensuring long-term sustainability. Dr. Lesco went on to discuss the importance of also engaging members of the community, including parents, NGO program managers, and representatives from religious groups.

“Youth involvement is one of the most important preconditions of a program for it to be accepted and affordable. Without the <a href="https://knowledgesuccess.org/2021/11/09/positive-youth-development-young-people-as-assets-allies-and-agents/">active participation of youth</a>, these programs are not possible.”

Dr. Galina Lesco

Ms. Esiet emphasized that while it’s important to engage stakeholders that are already supportive of the program, it is also necessary to engage with groups that may oppose AYSRH, as they often have the potential to effectively derail even well-designed programs. She highlighted the importance of actively involving youth throughout program implementation, specifically discussing her experience applying youth feedback to develop the educational materials given to students in the sexuality education program to ensure the curriculum was responsive to their needs and resonated with them. Ms. Esiet provided information about the sexuality education textbook that her program developed, “Family Life and Education Students Handbook.”

Where are the most cost-effective intervention points for governments in order to improve AYSRH outcomes?

Watch now: 51:47

Mr. Hayes described how these intervention points can differ greatly based on the different contexts of AYSRH service provision; because of this, strategies should be devised at the country level. He highlighted the diversity of multi-sectoral partners involved in the implementation of AYSRH programs and explained that reaching consensus among these stakeholders is often a cost-effective strategy for improving program outcomes. He also discussed the impacts of the COVID-19 pandemic: Many countries have experienced a massive reduction in economic growth, subsequently decreasing governmental revenue and placing additional financial restraints on already limited health budgets. Furthermore, the pandemic has introduced competing priorities for international donors who were previously focused on funding AYSRH programming. He mentioned the importance of aligning programs with the work already being conducted at the country level, integrating service provision into existing systems, and managing the scope of programs so as to ensure cost effectiveness. Finally, he emphasized the need for building a critical mass of resources behind evidence-based, high-impact interventions.

“The more that we can build consensus for context-specific high-impact interventions, the further we can stretch our resources.”

Brendan Hayes

About “Connecting Conversations”

Connecting Conversations” is a series tailored specifically for youth leaders and young people, hosted by FP2030 and Knowledge SUCCESS. Featuring five themes, with four to five conversations per module, this series presents a comprehensive look at Adolescent and Youth Reproductive Health (AYRH) topics including Adolescent and Youth Development; Measurement and Evaluation of AYRH Programs; Meaningful Youth Engagement; Advancing Integrated Care for Youth; and the 4 P’s of influential players in AYRH. If you’ve attended any of the sessions, then you know these are not your typical webinars. These interactive conversations feature key speakers and encourage open dialogue. Participants are encouraged to submit questions before and during the conversations.

Our fifth and final series, “Emerging Trends and Transformational Approaches in AYSRH,” began on October 14, 2021, and wrapped up on November 18, 2021.

Want to Get Caught Up on the Previous Conversation Series?

Our first series, which ran from July 2020 through September 2020, focused on a foundational understanding of adolescent development and health. Our second series, which ran from November 2020 through December 2020, focused on critical influencers to improve young people’s reproductive health. Our third series ran from March 2021 to April 2021 and focused on an adolescent-responsive approach to SRH services. Our fourth series began in June 2021 and concluded in August 2021 and focused on reaching key youth populations in AYSRH. You can watch recordings (available in English and French) and read conversation summaries to catch up.

Jill Litman

Global Partnerships Intern, FP2030

Jill Litman is a senior at the University of California, Berkeley studying Public Health. Within this field, she is especially passionate about maternal health and reproductive justice. She is FP2030’s Global Partnerships Intern for the fall of 2021, assisting the Global Initiatives team in their work with Youth Focal Points and other tasks for the 2030 transition.