Adolescent and Youth
Sexual and Reproductive Health
Counteract opposition to youth SRH services
Get key stakeholders’ attention
Ensure diversity of adolescents and youth in SRH programs
What do we know about digital health?
Address socio-cultural norms
Implement more integrated, multi-sectoral programs
Better engage/
partner with youth
Measure programs and incorporate AY feedback
Click a topic in AYSRH
Encourage policy implementation
Other health needs
Positive youth
development
Counteract opposition to youth SRH services
Get key stakeholders’ attention
Ensure diversity of adolescents and youth in SRH programs
What do we know about digital health?
Address socio-cultural norms
Implement more integrated, multi-sectoral programs
Better engage/
partner with youth
Measure programs and incorporate AY feedback
Encourage policy implementation
Other health needs
Positive youth
development
Over the course of 18 months, FP2030 and Knowledge SUCCESS hosted 21 sessions of Connecting Conversations. The series brought together speakers and participants from around the world in an interactive format to ask questions and engage in dialogues around timely topics in adolescent and youth sexual and reproductive health (AYSRH)*. The ten topics below represent the themes highlighted by the most common questions asked by participants of these conversations. Get answers to some of the most common questions by exploring the topics below. Answers have been edited slightly for clarity.
Dr. Angela Muriuki
– Distance.
– Cost.
– Opening hours.
– Fear of being seen and judged.
– Disrespectful treatment by providers.
– Provision of incomplete information and services.
– Restrictions on what services they can seek without parent and partner
permission.
Ms. Simon and Dr. Muriuki also noted that some of the characteristics of an adolescent responsive health system include:
Health financing
Health financing
Mechanisms to address cost as a barrier including elimination of user fees, inclusion of adolescents in insurance schemes, demand-side financing approaches, or performance-based incentive schemes that target adolescent health.
Health information systems
Health information systems
Availability of age and sex disaggregated data at all levels, within the national health information system and the use of such data for planning, management, and system improvement strategies.
Standard operating procedures for data storage to promote privacy must also be applied.
Health workforce
Health workforce
Mechanisms for pre-service and in-service provider training on clinical and interpersonal and communication competencies for adolescent health.
Training must also include opportunities to explore and address individual and social values and attitudes towards provision of services to adolescents.
Health systems should include adolescent health competencies in provider job descriptions and performance metrics.
Health service delivery
Health service delivery
Diverse service delivery points within a facility where adolescents can seek care. These include the outpatient department and maternal and child health clinic as well as the wider system of private facilities, chemists, shops, community health workers, and school clinics.
To the extent possible, services should be organized to account for adolescent needs and preferences, and service operating hours should not restrict access for school-going or working adolescents.
Ensure working intra- and inter-facility referral mechanisms as well as referral to services outside the health system.
Health commodities
Health commodities
Elimination of policy or legal restrictions to the access and use of contraceptive methods, such as those based on age and marital status.
Health leadership
Health leadership and governance
Meaningful adolescent participation in policy, planning, and accountability mechanisms.
The availability, dissemination, and use of adolescent health policies, strategies, and guidelines that address all health needs of adolescents.
Effective coordination mechanisms for ministries and partners working to advance adolescent well-being.
Community
Community
Strengthening existing partnerships between the health system and community programs and services that work with adolescents.
Partner with a range of community-based strategies to reach different groups of adolescents.
Go back to AYSRH topics
Click to read an expert response
Rarely do SRH concerns of young people occur in a vacuum, and many young people that have SRH needs seek other health services that are less stigmatized.
How can an adolescent responsive systems approach ensure that all youth health needs are addressed, such as mental health or maternal health?
Callie Simon
ASRH Team Lead and Senior Advisor
Save the Children
Dr. Jacqueline Fonkwo Co-Founder/ CEO Youth2Youth Cameroon
Other health needs
Read another perspective
Like everyone, adolescents have a wide spectrum of needs and preferences, yet global and national efforts to address these needs have often worked in silos.
What can we do differently to make our services more responsive to adolescents?
Health information, learning, and accountability
Health information, learning, and accountability
What do health care providers know about the national and sub-national trends in the needs of adolescents? What kind of data is being collected? Who is in need of this data? How is the collected data informing the daily practice of health care providers?
In my four years as a clinician, I was expected to collect certain kinds of data, yet there was never a time when I had any feedback on how I could use the data that I was collecting to improve my services for my patients. International donors and partners often request national-level data without supporting a system where data informs the daily practice of health care providers. There’s an urgent need to demystify data. We need to consider how this data can be used not only by donors and partners, but by health care providers.
The cost of care
The cost of care
Adolescents around the world depend on others to cover the costs of their health care expenses. Seeking SRH services in the company of guardians is not always an option given young people’s desire for privacy. More systematic approaches that consider the potential catastrophic expenditures that young people are not prepared for, especially when seeking services in the private sector, is an important step.
Essential medicines/technology
Essential medicines/technology
Strengthening existing partnerships between the health system and community programs and services that work with adolescents.
Partner with a range of community-based strategies to reach different groups of adolescents.
Read another perspective
Go back to AYSRH topics
There is an emerging emphasis on adolescent-responsive health systems. This signals an evolution from traditional stand-alone models of adolescent-friendly services toward a more systematic approach to making existing services more adolescent-responsive. This approach aims to incorporate service delivery elements that have demonstrated effectiveness in increasing adolescent use of available services. Responsive systems aim to address the multiple health needs of adolescents, including:
– Mental health.
– Communicable and non-communicable diseases.
– Injury.
– Pregnancy and childbirth.
These needs cannot be adequately met through separate spaces or specialized services models. They seek to address the unique system-level barriers and opportunities that influence how adolescents demand, seek, use, and experience health services. These include:
Acknowledgements
This webpage is made possible by the support of the American People through the United States Agency for International Development (USAID) under the Knowledge SUCCESS (Strengthening Use, Capacity, Collaboration, Exchange, Synthesis, and Sharing) Project. Knowledge SUCCESS is supported by USAID’s Bureau for Global Health, Office of Population and Reproductive Health and led by the Johns Hopkins Center for Communication Programs (CCP) in partnership with Amref Health Africa, The Busara Center for Behavioral Economics (Busara), and FHI 360. The contents of this webpage are the sole responsibility of CCP. The information provided on this webpage does not necessarily reflect the views of USAID, the United States Government, or the Johns Hopkins University.
This piece was curated by Brittany Goetsch (Knowledge SUCCESS) and Emily Sullivan and Cate Lane (FP2030). It was designed by Sophie Weiner and Emily Haynes, Knowledge SUCCESS. Photos courtesy of Lillibet Namakula and Images of Empowerment.
With special thanks to expert respondents: Callie Simon (Save the Children), Angela Muiriki, Dr. Jacqueline Fonkwo (Youth 2 Youth Cameroon), Fatou Diop (FP2030 Focal Point, Senegal), Lillibet Namakula (Public Health Ambassadors Uganda), Sean Lord (JFLAG), Ramchandra Gaihre (Blind Youth Association Nepal), Alu Azege (Media Health and Rights Initiative of Nigeria), Rebecka Lundgren (University of California at San Diego, Passages), Sia Nowrojee (Girl Up, The UN Foundation), Dr. Kristin Mmari (JHU), Dr. María del Carmen Calle Dávila (Andean Health Organization Hipolito Unanue Agreement, International Association for Adolescent Health (IAAH), Dr. Richard Lerner (Tufts University).
sources
i. WHO building blocks
ii. The integration of traditional medicine and western medicine
iii. Integrating community health and health systems framework
Sources
sources
i Chandra-Mouli, V et al. What Does Not Work in Adolescent Sexual and Reproductive Health: A Review of Interventions Commonly Accepted as Best Practices. Glob Heal Sci Pract 3, no. 3 (2015) :330-340
ii World Health Organization, Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation 2017, World Health Organization: Geneva.
iii World Health Organization. Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes.; 2007.
iv WHO building blocks
Sources
Read an expert response
The support of key groups (parents, religious/faith leaders, peers, providers etc) in young people’s lives often influence their decision to seek SRH services or use a contraceptive. How do we design programs that effectively engage these key groups and address opposition to ensure that young people are able to make informed decisions regarding their sexual and reproductive health?
Counteract opposition to youth SRH services
Read an expert response
What are some best practices in engaging governments to support evidence-informed adolescent and youth sexual and reproductive programs through policies and resources?
Get key stakeholders’ attention
Adolescent and Youth
Sexual and Reproductive Health
Answers to Common Questions
For more information, watch the Connecting Conversations recordings and read the webinar recaps of each session
According to Ms. Simon and Dr. Muriuki...
According to Dr. Fonkwo...
Presented by
Click to read an expert response
How can adolescent and youth reproductive health programs go beyond “one-size-fits-all” approaches to better incorporate diverse perspectives, preferences and needs of young people to ensure that underserved and vulnerable groups of youth are not left behind?
ENSURE DIVERSITY OF ADOLSCENTS AND YOUTH IN srh pROGRAMS
Ramchandra Gaihre Person with visual impairment, Founder/General Secretary, Blind Youth Association Nepal (BYAN)
Lillibet Namakula
Team Leader,
Public Health Ambassadors Uganda
Sean Lord
Social Worker, Youth Advocate,
Jamaican Forum for Lesbians, All-Sexuals, and Gays (J-FLAG)
Read another perspective
Go back to AYSRH topics
Another way to ensure youth programs are effective is by putting evidence into practice while using the words and experiences of youth to make programs more engaging and appealing. This also includes ensuring youth are involved in monitoring and evaluating what the program is doing.
To address adolescents and youth in their entirety, we must account for the voices of those who are most affected by the general approach taken by many programs. Young people must be meaningfully involved at all levels and all stages of adolescent well-being programming—from inception and planning to delivery and policymaking, youth engagement should also be representative of those the program aims to reach.
It is beyond time to recognize and understand the diversity of adolescents and youth and to acknowledge that a “one-size-fits-all” approach does not work. We must also continue to advocate for investments in the right policies and frameworks that affect the lives and well-being of adolescents and youth so youth can realize their full potential and [participate] in society.
According to Mr. Lord...
While the 21st century has seen some major and unprecedented transformations in the social, economic, political, and technological fields, our mandate as implementers and stakeholders is to continually reflect on the implications of these changes as far as young people’s rights are concerned and respond to them appropriately.
Peer education
Peer education
Training peer educators can be used as a multiplier-effect strategy to increase information flow, share experiences, and hold discussions and debates.
Edutainment and Informative Performative Arts Approach
Edutainment and Informative Performative Arts Approach (EIPA)
The EIPA approach fronts the use of creative forms for community awareness and sensitization through interactive, participatory, and fun sessions.
Technology and social media
Technology and social media
We should embrace the use of ICT in increasing access to SRH information and services. This can be done through the use of various social media platforms and applications where young people are engaged on various thematic topics.
As implementers, we need to use innovative and creative approaches that put young people at the epicenter of all programming. What are examples of these creative approaches?
Read another perspective
Go back to AYSRH topics
According to Ms. Namakula...
What comes in our mind when we talk about sexual and reproductive health and family planning? It’s curiosity, fear, pleasure, satisfaction, shyness, sameness, guilt, and/or being complete. It obviously depends on how an individual perceives these topics, but the society that we grew up in has shaped these feelings differently. In many societies, the topic of sex and sexuality is highly stigmatized and discriminatory, and there is much that isn’t talked about or shared. Adolescents and youth are not encouraged to discuss safely and openly. If any individual belongs to the minority group or disadvantaged community, this issue is even worse.
Read another perspective
Go back to AYSRH topics
According to Mr. Gaihre...
Ensuring the contribution of diverse youth voices and opinions is an important step when it comes to understanding the wide range of needs and expectations that youth may have of youth programs. Care must be taken to ensure that the perspectives of the most vulnerable and marginalized adolescents are addressed when developing community programs that are culturally appropriate and relevant. Youth programs should continue to provide learning and capacity-building opportunities while working at the pace of youth, supporting their efforts to make informed and positive life choices.
Making programs inclusive and diverse includes understanding the dynamics and influence of information technology in the lives of youth and considering how information technology could be better used for the well-being of youth and adolescents.
Youth participation can help to ensure the needs of all youth are being met and to identify programming gaps where special effort should be made to be more inclusive and diverse. Very importantly, act immediately on youth generated recommendations to improve programmes and maintain credibility.
Youth are resourceful and meaningful contributors, so they should be considered as partners in program and policy development and implementation. For their voices to be heard and valued, young people should be given meaningful opportunities to contribute, practice skills, and obtain experiences in leadership. It is important to involve them in the design, implementation, and evaluation of programs and policies that affect their health and well-being.
Some of the avenues that can be used:
Face-to-face engagements
Awareness campaigns
Door-to-door engagements
Peer-to-peer engagements
Recruitment of community-based change agents
It is also vital to identify, train, and mentor young people in leadership to confront the multi-dimensional challenges that affect their well-being. This can be done by building young people’s capacity to enable them to actively engage, lead, and influence change in their communities as well as strengthen youth leadership, community structures, and health systems.
By working with young people and influencers (i.e., parents/guardians, teachers, local leaders, opinion leaders, service providers, etc.) at the different levels and using different platforms, we will be able to see empowered young people taking control and ownership of their health.
Together, implementers and young people can mainstream young people’s concerns in the national and global development process and can contribute to improving their quality of life and standards of living, protecting and promoting their rights to health, education, information, and care.
Every society consists of diverse groups of youth regarding age, gender, gender identity, disability, sexual orientation, religious belief, education, and race and have diverse needs, feelings, and desires. Sexual and reproductive health and rights is recognized and guaranteed as a fundamental human right, but many societies (including government systems) have not been able to meet these rights of adolescence and youths. Being a youth with a disability myself, and growing up in Nepali society, I have encountered several such barriers and challenges in accessing such rights.
But unfortunately, these policies and programs are not able to meet the needs of all groups as they were designed and implemented using a blanket approach without consulting with youth. Moreover, adolescents and youth are only recognized as a beneficiary group. Lack of accessibility, judgmental behavior, negative attitudes, and a capacity gap in providing responsive services is resulting in low service uptake despite high SRH need among adolescents and youths.
Representing youths with disabilities, I have faced several such disparities and barriers in accessing friendly SRH and FP services. It might not be an intentional ignorance towards anyone, however one size doesn’t fit all. So the current SRH and FP services need to include an inclusive principle where diverse youth’s needs, desires, and their specific issues need to be integrated well.
How do you integrate the needs of youth with disabilities into your SRH and FP services? Find out what Mr. Gaihre recommends by clicking on the icons below:
Sign language interpreters should be provided in the service centers for the deaf youth.
Materials should be developed in an alternative format—such as using Braille and audio for blind youth, large print for low vision, and easy to read and pictorial for people with intellectual/learning disabilities.
The use of local language to disseminate the information is equally important.
Providers should be educated on providing non-judgmental and friendly services respecting the dignity of the diverse needs.
Some methods to ensure organizations and providers are able to provide non-judgemental and friendly services include:
Adapt the minimum standards/guidelines to promote inclusive services at all organizations and service centers.
Conduct an accessibility audit as an initial step to determine how well the organization or service center is providing services that all can access.
Consult target groups to design plans, policies, and activities.
Generate segregated data for effective planning and budgeting.
Sign language interpreters
Alternative formats
Friendly services
Local languages
Recordings
Recaps
Fatou Diop
Youth Focal Point PO/FP2030, Senegal
No program can adequately address the needs of youth if youth are not consulted in its development. Youth program implementers need to incorporate this perspective into their entire process, from data collection, to program design and implementation, to monitoring and evaluation, to information dissemination and service delivery.
Youth themselves best define the strategies that are most appropriate for them, because they are the ones living their lives. No longer should a program for youth be designed without youth. If young people design their own programs based on their specific needs, which they know better than anyone else, they will be more willing to take part in its implementation.
Program managers should encourage youth to work with them to implement their program. Young people have great power to mobilize and recruit their peers around many issues, including sexuality and health issues. If the program works in partnership with youth, it is more likely to be well received and have a better chance at success. Youth are leaders who can attract other youth into programs. This work must be a win-win, equitable partnership. There is no other way.
Listen
Listen
Create an advisory committee and conduct focus groups to get the opinions of young people in the target area.
Collaborate
Collaborate
Enlist one or more youth organizations in the area to help run the project together as a consortium. This strategy also helps strengthen the youth organization’s capacity and contributes to project sustainability.
Ms. Diop has two recommendations for strengthening meaningful youth participation in programs:
Go back to AYSRH topics
According to Ms. Diop...
Pick an expert response
As more and more people are accessing health services virtually, such as with telemedicine appointments and pharmacy refills, how do we ensure equity when it comes to digital access, availability, and engagement?
What do we know about digital health?
Trinity Zan
Associate Director, Research Utilization, FHI 360
Alu Azege
Director, Media Health and Rights Initiative of Nigeria
Telehealth is the use of electronic and telecommunications technologies to provide care and services at a distance. It has now become a mainstay, in part due to COVID-19. In 2020, as physical movement reduced drastically and, in most cases, stopped altogether, critical services like health needed to remain accessible to all. Globally, this gave rise to a vibrant digital life. Telemedicine has to catch up to this new normal mode of operation, regardless of its inherent limitations and must be [designed with] every human being in mind.
What measures can we adopt to make digital health attainable and sustainable? Ms. Azege has a few ideas...
Read another perspective
Go back to AYSRH topics
According to Ms. Azege...
Pick an expert response
What is the role of other sectors, such as education, in addressing socio-cultural norms to create a supportive environment for adolescent and youth reproductive health?
How to address socio-cultural norms
Rahinatu Adamu Hussaini
Gender Equality Adviser and Acting Project Director,
REACH Project,
Save the Children
Dr. Rebecka Lundgren
Professor, Center for Gender Equity and Health (UCSD); Lead, Learning Collaborative to Advance Social Norms (UCSD);
Director, Passages Project
Few factors affect sexual and reproductive health throughout the life course as much as socially constructed gender norms that define the roles and actions of men, women, boys, and girls. Social norms—the informal rules, often unspoken and unwritten, that govern which behaviors are appropriate within a given group—shape the life course of adolescents in many consequential ways. Supportive gender norms can help to promote more gender-equitable relationships as well as healthy sexual development. In most contexts, however, commonly held gender norms perpetuate entrenched power imbalances and create risks that lead to poor sexual and reproductive health outcomes. Addressing social and gender norms, such as expectations related to girls’ education and the appropriate timing of marriage and family formation, is fundamental to adolescent and youth health.
Read another perspective
Go back to AYSRH topics
According to Dr. Lundgren...
Khanna, T., Chandra, M., Singh, A., & Mehra, S. (2018). Why ethnicity and gender matters for fertility intention among married young people: A baseline evaluation from a gender transformative intervention in rural India. Reprod Health 15, 63. https://doi.org/10.1186/s12978-018-0500-0.
Beyeza-Kashesya, J., Neema, S., Ekstrom, A. M., Kaharuza, F., Mirembe, F., & Kulane, A. (2010). "Not a boy, not a child": A qualitative study on young people's views on childbearing in Uganda. African journal of reproductive health, 14(1), 71–81. PMID: 20695140.
Sources
sources
Read an expert response
Many times funding and policies address adolescent and youth reproductive health in silos, but for many years, advocates have called for a multi-sectoral approach that addresses multiple factors that influence AYSRH behaviors and outcomes. How do we implement more integrated multi-sectoral programs in this funding system?
implement more integrated, multi-sectoral programs
Sia Nowrojee
Senior Director, Global Community, Girl Up
UN Foundation
Feminist author and activist Audre Lorde said: “There is no such thing as a single-issue struggle because we do not live single-issue lives.” We have found that our youth leaders are effective advocates for multisectoral approaches that acknowledge and address the intersectional realities of their lives. For example, health does not exist apart from education, which is also linked to economic empowerment and other issues. Similarly, at the 3D Program for Girls and Women, we held that girls and women have multiple, intersecting needs that are best served when all stakeholders, including girls and women themselves, can come together to get things done.
Bringing different sectors together to address adolescent and youth sexual and reproductive health is challenging because health, development, and funding systems continue to be siloed. However, it is possible to do. Some of the lessons I have learned from designing and implementing multi-sectoral programs are detailed below.
Ms. Nowrojee has learned these key lessons from her program experience:
Go back to AYSRH topics
According to Ms. Nowrojee...
Dr. Sonja Caffe
Regional Adolescent Health Advisor, PAHO
Implementers must
deliberately promote factual
information. Scientific
organizations must ensure
that false or misleading
information is swallowed
by facts.
Promote factual information
Make programs more affordable
Going digital has to become more affordable, as low-
income earners also have a right to sound health
information and service. Information and content must
be made available on low data-consuming platforms.
Consider adopting the Facebook model, where digital
platforms offer free data modes. Availability must also be
made for Unstructured Supplementary Service Data
where internet services are not required. This is crucial,
as poverty rates are very high in some of our work areas.
Bring a human touch
Being digital further requires a human face. We must:
Create user-generated content that speaks to the needs of our audience.
Build a digital community.
Make it safe.
Speak our audience’s language consistently.
Communicate in their tone of voice.
Engage with them and do not leave them to the bots.
Moderate engagements and let users feel our presence.
Read an expert response
What are some ways that adolescent sexual and reproductive health programs can apply Positive Youth Development approaches in their activities?
Positive Youth Development
Dr. Richard M. Lerner
Director, Institute for Applied Research in Youth Development
Tufts University
Within the PYD literature, these actions are often termed the “Big Three” because they appear to be essential components in effective youth development programs.
Go back to AYSRH topics
Positive youth development (PYD) occurs when the strengths of a young person are aligned with key resources in their families and communities that enable that young person to thrive. Young people hold many strengths, including the agency and ability for intentional self-regulation, and optimism and hope for a positive future. Key points of convergence for cognitive, emotional, and behavioral engagement with young people to nurture these strengths include schools, community organizations, and faith communities.
According to Dr. Lerner...
1. Banati, P., Rumble, L., Jones, N. and Hendriks, S. (2021) Agency and Empowerment for Adolescent Girls: An Intentional Approach to Policy and Programming. In L. Lauxman, T. Archibald, E. Dowling, and C. Jessee, C. (Guest Eds). Special Issue on International Positive Youth Development, Journal of Youth Development, 16(2-3), 239–254.
2. Gavin, L. E., Catalano, R. F., David-Ferdon, C., Gloppen, K. M., & Markham, C. M. (2010). A Review of Positive Youth Development Programs That Promote Adolescent Sexual and Reproductive Health. Journal of Adolescent Health, 46 (3), Supplement, S75-S91.
Resources
resources
Key actions and mechanisms that support PYD include:
Relationships
Sustained, positive, and nurturing relationships with caring, committed, and competent adults.
Experiences
Experiences that enable the young person to develop the skills needed for positive, productive, and protective actions in the different contexts of their life.
Opportunities
Opportunities to participate and take a leadership role to apply these skills in family, school, and community activities that value their contribution.
PYD approaches can significantly contribute to efforts to improve and promote AYSRH. Youth programs that aim to prevent unintended pregnancy or HIV can make sure their program adopts and implements the Big Three components of effective youth development programs. At a minimum, all youth programs should ensure the presence of trained, available, and caring adults who can also act as role models and mentors, offering guidance and support in building the knowledge and life skills young people need to develop a sense of self, make healthy choices, set healthy goals, and develop resilience in the face of challenges and obstacles.
Read an expert response
Often, creating policies that are supportive of AYSRH is only the first step, and implementation of supportive policies remains challenging.
How do we ensure that governments are held accountable for effectively supporting the implementation of policies through the allocation of resources and dissemination of guidance to the district level?
encourage the implementation
of policies
Dr. Maria Del Carmen Calle Davila
Andean Health Organization- Hipolito Unanue Agreement
Vice President, Latin America
International Association for Adolescent Health
Go back to AYSRH topics
There are no rights
without a budget.
Guaranteeing the implementation of policies requires eight key actions:
According to Dr. Davila...
1
2
3
4
8
7
6
5
1
2
3
4
8
7
6
5
Work to make adolescent sexual and reprorductive health important at the national, subnational, and local authority levels.
Establish a sufficient budget to implement the actions that are considered in the policies.
Discuss the policies with subnational and local authorities. Incorporate the outcomes in the National, Subnational, and Local Strategic Health Plans.
Incorporate the outcomes in the National, Subnational, and Local Strategic Health Plans.
Make adolescent participation real and meaningful, and ensure adolescents have the power to hold others accountable.
Incorporate NGOs, Agencies of International Cooperation, Societies, and Civil Society representatives in the implementation evaluation.
Give incentives such as better salaries, training, equipment, etc.
Ensure work is inter-sectoral and multidisciplinary.
Click to read an expert response
How do we effectively collect and incorporate AY feedback on AYSRH programs, and how do we improve the participation of youth in monitoring and evaluation efforts?
measure programs and incorporate AY feedback
Dr. Josephat Avoce
State-Registered Nurse
Regional Manager, Adolescent and Youth Sexual and Reproductive Health Program
TCI in Francophone West Africa, IntraHealth International, Senegal Office
Dr. Kristin Mmari
Associate Professor
Johns Hopkins University
Bloomberg School of Public Health
Dr. Mmari also noted that seven processes for YPAR success have been validated:
Read another perspective
Go back to AYSRH topics
Impact indicators that aim to measure whether youth participation resulted in improved outcomes.
To effectively incorporate the voices of young people in youth sexual and reproductive health programs, organizations need to first consider how young people should participate in the process. Adolescents’ right to participation in all matters related to their own lives has been recognized in the Convention of the Rights of the Child, yet there is little consensus on what constitutes youth participation. Simply having a youth program within an organization does not guarantee meaningful youth participation. Most agree that meaningful youth participation means work with and by young people.
According to Dr. Mmari...
1. UNHCR (2006). UNHCR guidelines on formal determination of the best interest of the child. Accessed November 28, 2021.
2. Villa-Torres L and Svanemyr J. (2014). Ensuring youth’s right to participation and promotion of youth leadership in the development of sexual and reproductive health policies and programs. Journal of Adolescent Health 56: S51-S57.
3. Sabo-Flores K (2007). Youth participatory evaluation: Strategies for engaging young people. San Francisco, CA: Jossey-Bass.
4. Ozer EJ and Douglas L. (2012). Assessing the key processes of youth-led participatory research: psychometric analysis and application of an observation rating scale. Youth in Society: 10.0.4.153/0044118X12468011
5. Ozer EJ and Douglas L. (2013). The impact of participatory research on urban teens: An experimental evaluation. American Journal of Community Psychology 51: 66-75.
6. Wang CC. (2006). Youth participation in Photovoice as a strategy for community change. Journal of Community Practice 14: 147-161.
7. Ahumada C, Dekkers K, Mesman A et al. (2009). A step by step guide to creating sustainable youth-led organizations working on sexual and reproductive health and rights. Youth Coalition.
8. Van Arkel (2021). Meaningful and inclusive youth participation: Strengthening inclusivity. A planning tool for RHRN2 country coalitions. Rutgers.
Sources
sources
There are two types of indicators most used for assessing and evaluating youth participation:
Process indicators that aim to quantify the level and quality of youth participation.
The assumption is that meaningful youth participation—for example, in the development of a youth program—will result in a range of positive outcomes and benefits for both the program and the participants. Therefore, assessing both impact and process is essential.
Training in research skills
Practice in strategic thinking for influencing change
Building supportive networks
Adults sharing power with young people in the research and action processes
Power-sharing among youth participants
Fostering opportunities and guidance to work in groups to achieve goals
Developing communication
skills
(5)
Go back to AYSRH topics
Dr. Caffe has provided four best practices to get key stakeholders' attention:
Generating and sharing strategic information in a way that is easy to understand and interpret
National and local stakeholders in countries may not have access to all the information needed to understand the local status of adolescent health, trends over time, and how their situation compares with other countries or places. The data may be fragmented or incomplete. When developing adolescent health strategies or plans, the first step is always to create a comprehensive situation analysis and landscape analysis. This will help clarify the major health challenges and the appropriate response. Sharing this information in stakeholder meetings is always eye-opening for stakeholders. A very important component of data sharing must be illustrating the cost-effectiveness of investing in adolescent health.
Building key stakeholder capacity in critical areas of adolescent development and health
When people have done the same thing for many years, they may develop blind spots. As we learn more, we share more. As our understanding grows about the characteristics of adolescence, the developmental processes that occur, and their relevance across the life course, we gather the latest evidence on what works. Sharing this information and knowledge in capacity-building efforts generates new insights, commitment, and energy on the part of governments and national stakeholders to support evidence-informed adolescent reproductive health programs and policies.
Sharing lessons learned and fostering south-south collaboration
Empowering young people to advocate for their needs and to participate in all stages of programs
Because norms are socially constructed, youth programs must go beyond making health facilities youth-friendly by working to create, foster, and sustain enabling environments for sexual and reproductive health. Since young people learn and negotiate social norms within the context of the institutions that create and enforce them, programs must work within these same structures:
Generating and sharing strategic information in a way that is easy to understand and interpret
Building key stakeholder capacity in critical areas of adolescent development and health
Sharing lessons learned and fostering south-south collaboration
National and local governments may be reluctant to engage with the issue of adolescent reproductive health, as this remains controversial. Documenting and sharing lessons learned from other countries—in particular, experiences regarding how these countries have overcome obstacles—may motivate governments to also act, with the attitude of, “If they can do it, we can do it too.”
Young people are best positioned to advocate with governments to have their sexual and reproductive health needs met. Information-sharing and strengthening of their advocacy skills can help them be more effective and take informed action.
Empowering young people to advocate for their needs and to participate in all stages of programs
*AYSRH and ASRH are used interchangeably in this piece.
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Youth participatory evaluation (YPE) is the process of involving young people as evaluators: partnering with them to shape their own evaluation questions and indicators, develop unique data collection methods, analyze the collected data, and disseminate the findings.
While the evidence for the wider adoption of this approach is limited, the use of YPE signals a shift in the evaluation of youth programs, emphasizing the need to see youth as more than intervention subjects and research beneficiaries. Hopefully, approaches where young people actively participate as consultants, partners, and directors in designing the evaluation study will become common practice.
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Youth-led participatory action research (YPAR) trains young people to identify problems or issues of concern to them; conduct research to better understand the origin of those problems; and translate the research into programming and policy.
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More evaluation and documentation are needed to identify best practices for youth participation across social settings and cultures.
Photovoice is a promising youth participatory approach for both research and evaluation.
U.S. research has found that a key ingredient for effective youth participation is ensuring that young people are properly integrated within an organization. Volunteer positions or low-paid internships, although valuable for gaining experience, have the potential to demoralize young people. Additionally, unequal power relations between adults and youth may curb opportunities for young people to speak up honestly, so supporting them to develop organizational and soft skills such as working in groups, public speaking, and communicating with different audiences contributes to greater participation.
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Above all, organizations must remain mindful that gender, race, ethnicity, sexual orientation, and other social categories, including their intersections, can privilege or marginalize young people. Opportunities are not equal. Organizations need to analyze and address factors that perpetuate marginalization and unequal power dynamics within their cultural context and commit to changing them within their programs as well as their own structures.
For more information on youth participation and how to plan for it, please see this guide.
Many of these norms are deeply rooted and influence multiple outcomes, including women's ability to time and space their pregnancies, remain free from violence, and attain higher-level education. Sometimes called meta-norms, they sustain systems of authority, control, violence, gender ideology, protection, privacy, and social status. They exist within a complex web of culture and are influenced by belief systems, embedded in formal and informal institutions, and produced through social interactions. Young people learn what is expected of them from social structures such as the family, school, religious organizations, and community groups. These social expectations are further enforced and sustained by people who matter to them through a combination of sanctions and rewards.
Want to read more about soclal norms and AYSRH? Dr. Lundgren recommends these resources from the Institute for Reproductive Health:
The Social Norms Atlas: Understanding Global Social Norms and Related Concepts
Social Norms and AYSRH: Building a Bridge from Theory to Program Design
Develop a vision
Develop a vision
Develop a clear, shared vision with jointly identified indicators of success.
Conduct joint planning
Conduct joint planning
Conduct joint planning, but everyone does not have to do everything. In fact, each stakeholder should only do what they are good at. It is possible to implement separately as long as each stakeholder is working towards the shared vision and jointly identified indicators of success, and there is regular communication between stakeholders to share updates, address problems, and assess progress.
Engage stakeholders
Engage stakeholders
Ensure each stakeholder has a clear sense of what their relative advantage is and how their own outcomes will improve by engaging in the multi-sectoral program.
Include youth
Include youth
Ensure youth representatives are included in planning, implementation, and monitoring and evaluation.
Identify funds
Identify funds
Identify funding needs and encourage stakeholders to bring their own funding to the table.
Explore partnerships
Explore partnerships
Move beyond the usual sectors and engage a range of stakeholders, including local government leadership, the public transport sector, and corporate sector job training programs.
Learn more
Learn more
The UN Foundation implemented the 3D Program, which aimed to tackle many of these challenges. Click on the title to learn more about each From Vulnerability to Leadership report:
Lessons Learned from Collective and Collaborative Action for Rural Girls and Women in India
Lessons from a Multi-Sectoral Initiative for Women Waste Pickers in India
Initiatives that model new behaviors, catalyze reflection, and advance new ideas in the spaces young people spend time—such as their homes, churches and mosques, and schools—can shift expectations of appropriate behavior. In fact, education programs provide key opportunities to communicate new social expectations, teach critical thinking, and develop the assets young people need to realize their aspirations even in the face of restrictive social norms (Khanna et al 2018, Beyeza-Kashesya et al 2010).
Families
Educational settings
Health systems
Religious institutions
Communities
The Photovoice process provides young people with cameras to photograph their communities and participate in critical dialogue and knowledge-sharing about personal and community strengths and concerns. YPE, YPAR, and Photovoice have all proven effective for developing and adapting sexual and reproductive health interventions, strengthening leadership capacity among young people, and increasing knowledge-sharing skills, role modeling skills, and program ownership.
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Formalize adolescent and youth involvement and provide them with the legal capacity to contribute.
On collecting and incorporating feedback, Dr. Avoce advises...
Institutions must recognize the roles that youth can play in decision-making processes. It is necessary to support their recognition in the eyes of nations’ laws, regulations, and policies. Their participation should be recognized, logged, and authorized by public ministries and in official paperwork. This approach should be extended to include youth associations in countries’ Official Gazettes. In this way, young people can make their voices heard where it counts, in official capacities and as their own legal agents, rather than just as a physical presence in the room with no backing or credibility behind their input. When they can take the stage as their own legal entity, they can drive actual change.
Learn more about Ms. Azege's digital health work on Love Matters Naija.
This is a very important and very tough question! I have been engaged in digital health for more than a decade now, and there is an eternal sense of optimism—that I generally share—about how these technologies can address, and overcome, the challenges that many people face, especially youth. From my earlier days working on m4RH, a simple SMS service that provides essential FP/RH information on-demand, I saw that young people appreciate the confidentiality and privacy that digital tools offer. However, there are also very real concerns about who does and does not benefit from this potentially catalytic platform.
We can’t assume that everyone will have equal access to technology, or have equal capacities to use it in positive, helpful ways. As with general principles of people-centered programming, we should:
Include our intended audience in the design phase so that they can identify their challenges and inform how technology may (or may not) be able to address those challenges.
All of this makes for a strong and informed theory of change for our digital interventions. A fantastic resource that lays all of this out is from the WHO: Youth-centered digital health interventions: a framework for planning, developing and implementing solutions with and for young people. I had the pleasure of contributing to this and I think it is very accessible and relevant. I hope you’ll check it out!
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According to Ms. Zan...
I just read an article today about the constraints that can limit young people’s access to the internet in LMICs. Not surprisingly, they mirror the barriers that young people face in accessing SRH services—that is, issues of affordability, lack of locally appropriate and accessible content, and restrictions on their behavior and mobility. So, although digital can address some challenges for some people, platforms and tools must be developed and implemented thoughtfully in order to avoid making inequities more severe.
Do our homework and collect data that further illustrates the problem and the potential for the solution (e.g., unmet need among target audience, percent of intended users who are literate, percent who report being able to access phones).
Find data disaggregated by age, gender, geography, education, etc. if at all possible.
Keep collecting data as part of our monitoring and evaluation efforts so that we can determine if the digital intervention is yielding the intended outcomes, and if those outcomes are equally experienced by all groups.
Adolescent sexual reproductive health (ASRH) should be addressed holistically because of the negative social and gender norms that affect its positive outcomes. It is very important to design projects through a transformative and socio-ecological approach. By being transformative, you examine and address the root issues affecting adolescent SRH. Using a socio-ecological approach allows you to focus on the adolescent and on every stakeholder that is part of their complete wellbeing, including parents, caregivers, service providers, and policymakers.
ASRH remains a very sensitive issue in many communities around the world. The general context might be the same, but it is very important to conduct research, including gender analyses and social norms explorations, on behaviors and attitudes that contribute to negative ASRH outcomes. This research will also give you a better understanding of how to design and implement your ASRH intervention, including identifying your target audience at the community level (apart from adolescent girls and boys).
So, how should you design your intervention and engage other stakeholders to create a supportive environment for ASRH? Interact with the class below to hear Ms. Hussaini's suggestions.
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According to Ms. Hussaini...
Creating gender-responsive safe spaces and providing Comprehensive Sexual Education (CSE) and life skills through participatory learning activities, using best practices like Save the Children CHOICES, GREAT and SHOW peer Educator manual (Plan International), etc. have proven to be a good means of sharing information, increasing access to and use of SRH services, encouraging meaningful participation and holistic wellbeing for adolescents (including healthy behaviors), and reframing and challenging negative social and gender norms. These manuals and approaches can easily be mainstreamed into the extracurricular activities of schools, apart from community-level safe spaces.
Use best practices
Include elders and religious leaders
Engage parents
Develop strategic plans
Engage stakeholders
Developing strategic collaboration plans for health and education stakeholders that clearly state the importance of multi-sector engagement/integrated approaches to improving ASRH outcomes allows everyone to understand their role. Projects can work directly with teachers and health workers to strengthen gender-responsive services, reduce provider bias, improve counseling methods, and understand the importance of CSE for the wellbeing of all adolescents. The use of strategic behavioral change communication that is gender-sensitive and context-specific will cement these gains and help address any biases or concerns expressed by parents, education and health professionals, or community members.
Engaging parents about positive parenting and building their capacity to actively participate in the learning and health of their children shows encouraging outcomes for ASRH as well as overall youth wellbeing. These include improved rates of school enrollment, retention, and graduation—especially for girls, which delays early and forced marriages and unions.
Including traditional and religious leaders (RTL), community elders, and adult women (i.e., grandmothers) is essential. Building their capability to understand ASRH, gender equality, and inclusion is vital to the wellbeing of adolescent girls and boys. Using innovative, community-based best practices and modules like Save the Children VOICES and PROMISES, including positive parenting and positive masculinity, can support discussions with community members and leaders, giving them a better understanding of how they can support ASRH.
It remains important to engage education and health stakeholders (including policymakers) on the importance of formulating, reviewing, and implementing policies for adolescents that are gender-responsive and -inclusive. These policies help guide the work provided at the health service centers.
Significant participation from young people is both a means to an end and an end in and of itself.
It should not be an abstract concept that is void of meaning and founded on empty words. Rather, we take these concrete actions to achieve measurable results. Otherwise, youth participation can become a tokenistic fad. The kind of participation in question here must put young people in essential or key roles in program planning—roles which urge adults to rely on them and their voices.
On youth participation in monitoring and evaluation...
Ensure that all of the data we collect during the monitoring and evaluation processes is disaggregated by age, sex, marital status, and gender.
Primary data collection tools, like notebooks, forms, and registries, must be set up so that we can collect information on these demographic variables. The same goes for questionnaires, reports, tables, and guidelines. Furthermore, the databases we consult (Health Management Information Systems or Demographic Health Information Survey-2-HMIS or DHIS-2) should also be set up to collect disaggregated data, even if it’s just disaggregated on the grounds of the “age” variable if all else fails.
Be aware of the fact that youth don’t have to be certified health workers before they can get involved in the monitoring and evaluation processes.
From the early drafting of a project’s or program’s documents, evaluative research protocol and the terms of reference for quality control should incorporate the participation of young people. They should be involved from the start, from the design of the monitoring procedures, to the development of the tools, from the actual data collection, to finally processing and analyzing that data before disseminating the results. Before getting started, you should also specify the number of young people you plan on inviting to participate in this process.
Integrate baseline expectations of—and opportunities for—youth engagement into the design of monitoring and evaluation tools.
We must gather and account for young people’s feedback on the quality of the reception and services they receive. We must encourage program managers, including health managers and health authorities, to invite youth representatives to discussions regarding the monitoring and evaluation of services, even when these conversations are taking place in formal health facility settings. This setup allows us to take youth perspectives into account when making plans for program improvement.
Leverage social media.
The social media platforms dominated by young people are useful channels for collecting constructive qualitative feedback on how youth programming is being received. For example, health authorities could monitor a unique WhatsApp number that has been set up to collect this kind of feedback. A youth committee can then conduct routine meetings dedicated to analyzing this feedback and deciding how to act upon it.
Overall, these approaches all constitute strategies that can be adopted in order to better incorporate young people into monitoring and evaluation activities. But everything must be founded on the trust and synergy fostered between adults and young people.
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For example, on one of our teams, we designated two youth leaders (ages 18–24) as “mandatory signatories” of the project’s bank account, meaning, when withdrawing money from that account, both the youth leader and one adult needed to sign off. This practice of co-signing checks and any other paperwork that allowed for the release of youth project resources is a strategy that forces managers to give youth their due place at the table.
When young people are put into central leadership and implementation roles on project teams, their voices actually count. They have an actual say in the project’s terms of reference, implementation processes, and partnerships, because they’re the ones allocating the resources. Their voices are heard. Over the course of one year, the youth assigned to this particular project co-signed about 40 checks, all while they followed the processes of fleshing out plans and developing activities. The young people got to play an influential role here. They were considered partners and key actors, not just beneficiaries. We need to place youth in important positions of power, where they can make calls on how best to use resources—especially financial resources. As in this example, they can object to the signing of a check if they don’t agree that something is a worthy expense. Hence, they have power that they can exercise.
Engage stakeholders
Engage parents
Develop strategic plans
Include elders and religious leaders
Use best practices
Being a youth with a disability myself, and growing up in Nepali society, I have encountered several such barriers and challenges in accessing such rights.
In Nepal, many laws are promising to ensure adolescents and youth friendly SRHR and FP services.
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