Umoyo Wama Youth Project

Umoyo Wama Youth Project Young Health Programme – Zambia

Interim Report July 2011 – March 2012

1 In collaboration with AstraZeneca and Planned Parenthood Association of Zambia

2 AstraZeneca – Young Health Programme (Zambia) Interim Report July 2011 - March 2012

Project AstraZeneca Young Health Programme Zambia: Umoyo Wama Youth Project name:

Project locati Eight communities of Chadiza Programme Unit, Eastern Province, Zambia on:

Project durati Three Year Project (July 2011 – June 2014) on:

The focus of Young Health Programme in Zambia is on adolescents of Chadiza District in Eastern Zambia. Chadiza is a remote rural area with traditional cultural practices that are associated with a high prevalence of early marriage and early pregnancy. Over three years the project is expected to reach approximately 30,000 people across Chadiza. Targeted Benef Direct beneficiaries: 6,000 girls and 4,000 boys (10,000 direct young people in total) between the iciarie ages of 10 – 24 years. s Indirect beneficiaries: 20,000 people comprising women, men, girls and boys in the general Chadiza population.

Please note numbers (targeted communities, beneficiary numbers etc.) refer to the original proposal – the extension activities will be reported on in the next period.

Goals and Objectives

Goal: To improve the health and well-being of adolescents in Chadiza District

Objectives: . To mobilise community support and increase advocacy for improved access and quality

3 of young people’s health services.

. To promote information sharing, education and communication for adolescents on relevant health issues.

. To strengthen and improve the existing health services to provide quality youth friendly services. Outcomes

Summary of main achievements:-

The Young Health Programme in Zambia is a new initiative focussed on adolescent sexual and reproductive health for young people in Chadiza district. The programme is delivered in collaboration with local partner Planned Parenthood Association of Zambia (PPAZ). The programme started in July 2011 (implementation from October 2011) and this is the first period reported upon. During this initial phase the programme has focussed on ensuring an effective start-up and initiating activities in several key project areas. During Year one, the project has concentrated on four of the eight targeted communities.

Some of the key achievements from this period include: Start-up workshop carried out Key partnership secured with the government and an Memorandum of Understanding (MOU) signed 21 Peer Educators (11 girls and 10 boys) trained on communicating issues around sexual reproductive health and rights 16 drama group members (eight male and eight female) trained and equipped to run performances around sexual reproductive health and rights issues Training of parents and community elders on topics of sexual and reproductive health and how to interact with young people to enhance their health Highlighting of key SRHR messages to a wider audience at various international celebration day events 12 community sensitisations that have reached an audience of 1,024 to hear and discuss key topics around adolescent health Establishment of youth-friendly corners in clinics in each of the four communities Training of service providers, traditional healers and youth counsellors in adolescent health issues and communication and counselling skills Establishing four quality of care committees to monitor the provision of services to young people Media training carried out with peer educators in radio programming and personnel from media houses orientated about the Young Health Programme.

Objective One: To mobilize community support and increase advocacy for improved access and

4 quality of young people’s health services.

A stakeholder mapping exercise was conducted by holding meetings with various district officials through the office of the District Commissioner. These included the officials from the ministry of health, education and PPAZ. During this process the project identified specific targets for implementation including communities, health facilities and schools. A baseline survey was carried out and the results are being used to feed into the project design. During the project initiation, the project team met with the officials from the Health and Education departments to introduce the project and its purpose. The project team also visited selected health facilities and school to look at the prospective project sites and met the local staff. A start up workshop was held in October 2011 and involved 29 participants including representatives from the District Health and Education authorities. The workshop helped create a clear and common understanding of the situation of adolescent health in the area and the focus of the YHP, build links between the stakeholders and launch project activities.

In December 2011, training was carried out for 16 drama group members from the four communities targeted by the project in Year one. The training focussed on issues of SRHR and supported the members to develop sketches focussed on messages around health and rights on this theme. The members received drums and drama attire to support them in their activities.

Training was also carried out specifically targeting parents and community elders. The aim of the training was to enable the participants to understand the special needs and challenges of adolescents as they grow up, and to be able to effectively interact with them and support them. Additionally the training aimed to encourage the participants to mobilise young people and advocate for youth friendly health information and services.

The project participated in a number of international celebration days, taking each one as an opportunity to highlight relevant issues of adolescent health through community sensitisations and the distribution of t-shirts. One of the drama groups was invited to perform to guests attending Plan’s 75th Anniversary celebrations in March 2012, showcasing the work of the YHP to a wide Zambian audience.

Objective two: To promote information sharing, education and communication for adolescents on relevant health issues.

In this first phase, the project has extended knowledge and information among young people on a variety of reproductive health issues such as STIs, contraception and rights, and has begun to empower them to promote activities that address issues concerning their health.

Peer Educators were chosen from each community with support from the community development facilitators and clinic workers. Selected Peer Educators were between the ages of 16-25 who had

5 demonstrated an interest in health or in engaging in community work. Twenty-one Peer Educators from the four communities received training to enable them to lead discussions with their peers and communities about issues relating to sexual and reproductive health needs and rights of adolescents. As part of the training the Peer Educators developed a timetable and action plan of activities to be carried out within their communities.

Peer Educators and Drama group members have subsequently together carried out 12 community sensitisations across the four communities. The typical format of the sessions is for drumming to be used to invite people to gather, drama performances (see box below) are then used to engage the audience and convey key messages about health or rights, for example the right for a young person to say no to sex or to protect themselves. Humour and exaggerated mime serve to defuse, and open up, subjects that are typically considered taboo. This is then followed by discussions supported by the Peer Educators, Community Development Facilitators (CDF) and sometimes clinic staff. Peer Educators are then available for individual discussions should anyone want to talk privately. Issues raised include young people who have concerns about early marriage, falling pregnant, or are considering illegal abortions. These community outreach activities are expected to increase the utilisation of health services at the local facilities.

Peer Educators also participated in a traditional Nc’wala festival in Chipata. This is an annual celebration showcasing the Ngoni tribe and for which people travel from across Zambia to attend and was an opportunity to reach out to a large number of young people and elders with reproductive health information and the availability of services at the local young friendly corners.

The first Youth Action Movement (YAM) meeting was held in March 2012 to provide a forum for Peer Educators to discuss challenges they faced. During this meeting challenges identified included that the YAM did not have a strong committee in place and the group did not have a work plan. The outcome of the meeting was that an interim committee was selected and a work plan developed to guide their future plans.

Radio programmes will begin airing in July 2012. Leading up to this the project has been laying the groundwork for the programmes through consultation with stakeholders to identify a variety of participants to appear on the shows. These are likely to include health workers, young people, teachers, community leaders and the men and women who carry out the initiation ceremonies. The aim is to look at adolescent health issues such as abortion and cultural practices from a broad range of perspectives and to get the wider population thinking and talking about these issues. Training has been carried out for the peer educators in media programming and also with media personnel to explore how the media houses and the project could work together in delivering outcomes through broadcasting.

Objective three: To strengthen and improve the existing health services to provide quality youth friendly health services.

6 During the first few months of the project, activities have taken place to ensure that youth-friendly services have started to be made available to young people through the health facilities in the project area sites. These include youth counselling, targeted reproductive health information and the distribution of condoms.

Training was carried out for health service providers, both those who work in the clinics in the four targeted communities, but also for more informal providers including traditional healers and community-distributors of condoms. The training focussed on key SRHR topics and also wider behaviour-change management, communication and counselling skills. The training sought to equip the service providers with the skills to deal appropriately and sensitively with young people referred to them by the peer educators during the community sensitisations. The traditional healers were trained to also refer young people to the health clinics when they approached them with problems beyond their ability to heal (for example STIs). An additional training was held for youth counsellors covering similar topics with a greater emphasis on the counselling and communication aspects. The youth counsellors will not only provide counselling services to young people as required, but will also refer them where appropriate to clinical services.

A Youth Friendly Corner (YFC) was established in each of the four clinics targeted in the initial phase of the project. Each YFC was equipped with a variety of board games such as checkers that appeal to adolescents. In the next quarter, each corner will additionally be furnished with furniture and posters. By creating the corners in each clinic, the project is creating a safe and fun space to encourage young people to visit the clinic, and to make it easy for them to go onto to access health services they may need. In each area a Quality of Care committee was established with representatives from the community. The committees were briefed on issues of adolescent health and agreed a list of criteria to look at to assess the quality of service provided to young people. The next step for the committees will be to carry out assessments of their clinics against the criteria which will be used to bench-mark progress.

7 Progress again st Please see Annex one - Progress against logframe indicators indica tors Global Indica Please see Annex four tors Project activit Please see Annex two - Progress against activity plan ies: A key challenge faced by the project in this first phase was the delay in starting the execution of the Project project as planned. The project had originally been planned to start earlier in 2011 but implementation challe was held back until after the start up workshop in October 2011 to ensure all parties had a clear and nges: common understanding of the project design, methodologies and focus. As a result some activities (such as the boys and girls clubs and the radio programmes) were moved back to be implemented in future quarters. The reschedule will see the project catch up to the original activity plan by the early part of Year two.

The location of the project is very remote and this poses logistical challenges in reaching communities (the closest community to the Plan Zambia office in Chipata is around two hours away along poor dirt roads and paths). This was known at the outset and the project has deliberately set out to target hard- to-reach communities where young people are particularly vulnerable. The project is working closely with the CDF’s in each community who are already present on the ground and has agreed communication channels with them according to what is most appropriate (for example in communities where there is limited phone network, the health coordinator will text the CDF to request a phone call, the CDF will periodically walk to an area of the community where the signal is strong enough to pick up messages). During the rainy season (November – March), some of the communities become inaccessible so project scheduling has been built around this. The project has also selected the closest four communities to work with in the first phase of the project, so that learning can be applied when the reach is extended to the additional more inaccessible communities.

The 2011-2012 rainy season was very heavy in places and caused flooding and damage to property in parts. In Zemba community (one of the four communities targeted in the initial project phase) the rains blew the roof off the rural health clinic so that part of it including the room established as a youth friendly corner cannot be used. The materials including games were rescued and are currently being stored in the drugstore as a temporary solution. The government has agreed to replace the roof and it is hoped the youth friendly corner will be up and running again properly by the end of June.

There have been a number of challenges with the baseline survey carried out in the early stages of the project. There is limited capacity in this part of Zambia to carry out a survey of this nature and the

8 resulting draft report has not provided the quality of specific data that is useful for measuring indicators of progress of the project. Information gathered also indicates there were issues with the approach taken by researchers which may have inhibited the answers of young people to some of the more personal questions, regarding their sexual and reproductive health. Plan have provided input to support PPAZ and the consultant to revise the report to analyse the available data and make use of the useful contextual information it has gathered. Whilst a set-back, this has provided a useful learning experience for Plan about the level of support required before, during and after a research project of this nature is carried out. Plan and PPAZ are identifying gaps in information that can be incorporated into the forthcoming research piece to supplement the baseline data held. Highlights of the baseline will be shared with AstraZeneca in mid June and the advocacy research will follow this.

An additional challenge has been young people dropping out of the programme after they have been trained due to personal circumstances. A small number of young people in the project so far have left the programme due to marriage or moving away to a different part of the country for a variety of reasons. To counter the issue and ensure continuity and sustainability the project is continuing to recruit new young people onto the programme and will run additional training for new Peer Educators.

Finally, changes in staffing in Zambia have caused some delays around non- programmatic elements of YHP such as volunteering. One volunteering opportunity has been pushed back until 2013 when the office has more capacity to fully support the volunteer.

9 The YHP is still in its early stages in Zambia but the design of activities to date has incorporated various approaches to ensure ownership and sustainable impact. The project has actively sought to ensure full participation of key stakeholders including community members and the beneficiaries throughout the design and implementation of the project to date.

Participants in the start-up workshop included district health and education representatives to start building long-term support for the programme and support coordination between key players. Plan Zambia have a very positive relationship with the local authorities in Chadiza which is very constructive for obtaining local health statistics or permission to carry out activities in conjunction with the rural health clinics. Building links with the education authorities has provided a conducive backdrop to working with schools to identify young people to participate in the boys and girls clubs.

Since inception, the project has helped build a strong relationship with stakeholders such as Office of the District Commissioner, the District Health Management Team (DHMT), the education local authority and other government departments who have welcomed the Young Health Programme, recognising its potential to complement Government efforts. The signing of the MOU with the Ministry of Health at the national level has provided a supportive framework to enable DHMT to engage with the project at district level. The support and commitment of the DHMT is crucial to ensuring long term outcomes of the project so this is an important step. Involvement of the Office of the District Commissioner through mobilisation of the local stakeholders such as the local education authorities Sustainability and community leaders has further helped build support to create an enabling environment for the project implementation. One of the positive results to emerge from this already is that the DHMT has created offices for focal point persons at Rural Health Centres (RHC) level and has provided office accommodation for youth-friendly corners.

Community ownership of the YHP has been encouraged through supporting community members to play a role in identifying young people to be trained as peer educators and drama group members. Youth ownership is generated through the training of young people in drama and peer education who then themselves deliver health messages to their communities.

Some peer educators have begun to explore possibilities for income generation activities (such as rearing pigs) to support activities they are carrying out. This is an early stage of development but may also prove a useful way of continuing to engage older adolescents in the programme as an opportunity for their skills development.

10 AstraZeneca employees have raised an additional £85,000 to support extension activities for the programme. It has been agreed that these activities will include replicating the activities taking place in the eight initial communities into a ninth community (Tafelansoni) also in Chadiza. The employee AstraZeneca funds will also support local and national advocacy work with the aim of ensuring that long-term involv change goes beyond the life of the project. These activities will ensure that the new government ement makes a commitment to prioritize adolescent SRH information and services. Particularly funding for ongoing support of the ‘youth friendly corners’ and contribute towards enforcing the legal age of marriage thus addressing issues of early marriage.

At the field level, the majority of activities are delivered by local partner Planned Parenthood Association of Zambia (PPAZ) who are experienced in working on sexual and reproductive initiatives. Plan are directly involved in the implementation of the media and advocacy activities and also provide Project technical support and overall coordination and management of the programme. The programme is mana enabled through Plan’s existing presence in the targeted communities through the resident CDFs, geme and wider project links with key stakeholders including government and local leaders. nt, monit The health coordinator is based in the Programme Unit office in Chipata and oversees the work of oring PPAZ and the eight CDFs resident in each of the targeted communities. He receives technical and support from the Health Programme Manager based in the Plan Country Office in Lusaka. evalu ation: PPAZ and Plan jointly oversee the project implementation, supervision and monitoring. The project team facilitate implementation of the activities, regular monitoring, monthly and quarterly reports. Project impact is being monitored by the project team against the indicators in the project logframe.

Quotes and “ From the workshop I have learnt a lot of things, the workshop has opened my mind and I have photo gained knowledge of VCT [Voluntary Counselling and HIV/ AIDS Testing], dangers of unsafe s: abortion, defilement cases and teenage pregnancy”. Tandie, drama group member

“Generally speaking, there is an increase in family planning users who are young women and now people have the knowledge and they can report defilement cases and victims are able to get treatment for sexually transmitted infections which will help reduce teenage pregnancies in Zemba community”. Andrew Phiri, manager of Zemba Rural Health Clinic

‘The project is having an immediate impact. We are seeing lots of young people accessing condoms.

11 We are also seeing young people who did previously not report STIs now reporting and receiving prompt treatment. This is very encouraging and we are optimistic about the long-term impact on the community’ Tobias Hamunchenjie, Community Development Facilitator Zemba

‘Our pupils have received information about child rights and health issues. Even our teachers have benefited from workshops as part of the Young Health Programme. Most of our pupils are now aware of their rights. We are very happy about this and hope it will continue’ David Mulenga, Headteacher of Zemba Basic School

‘The Chief is very happy. Because of workshops and other initiatives a lot of parents are supporting their children to stay in school. Young girls who used to go for initiation ceremony are now given time outside of school to go so they do not miss their education. It is for this reason we urge you not to stop but to keep educating us. This is the message the Chief sends’ Sanida Phiri, representative of Chief Zingalume of Chilenga

‘The issues of STI are common here, as are early marriage. AIDS is a very serious issue in Chadiza. For me I currently care for 6 orphans at my home because of this disease. One of the biggest issues here is education dropout as children are taken out of school. To discourage this, the Chief is fining families who take their children out of school to herd cattle. Initiation ceremonies can have negative effects on the lives of adolescents as after learning, they want to go straight out and practice what they have learned. This is a very difficult issue. Because of information they receive, we are now seeing a reduced rate of children having to stop school as they are pregnant, Peer to Peer education is very key to this’. Cephas Tembo, representative of Chief Zingalume of Chilenga

‘What we do as Peer Educators is to go for outreach in the schools and communities and with the drums we call people to come. We teach these people especially about issues of health. The other activity we have is to be a youth-friendly listener. We have lots of young people approach us to talk about issues of concern such as young ladies who are pregnant and are thinking of causing an abortion. We also talk to young people who are married and teach them how they can stay in their marriages whilst taking care of themselves. If young people are afraid of HIV infection we refer them to trained counsellors. We see to it that cases of rape are reported to the police. These are important changes.’ Namwene, 18, Peer Educator

Photos

Drums calling community to gather to hear health messages

Drama group performing sketches around key health messages

13 Meeting with Plan, PPAZ and local leaders

Zemba Rural Health Clinic with missing roof

Clinic worker trained in providing youth-friendly services

Rural settings of communities in Chadiza

15 Annex One Progress against all indicators Progress against all indicators within log frame Number: Total number: Comments Current reporting period Programme to date Goal Level o Reduced reported teenage pregnancy Project activities are on Impact and results will be seen in going year 3 o Reduced reported early marriages Project activities are on Impact and results will be seen in going year 3 o Increased access and utilisation of Youth Friendly Services Project activities are on Impact and results will be seen in going year 3 o increase in knowledge of health and reproductive health issues Project activities are on Impact and results will be seen in and rights going year 3 Objective 1: Outcome Level 1.1 Increase in advocacy and lobbying capacity of Local Non- Project activities are on Impact and results will be seen in Government Organisations, Community Based going year 3 Organisations and other community action groups

1.2 Demand for quality adolescent health Project activities are on Expected by the end of Year 1 services for both girls and boys are going increased 1.3 Improved access and quality to young health services Project activities are on Impact and results will be seen in going year 3 Objective 2: Outcome Level 2.1 Increase in knowledge of health issues and prevention among Project activities are on Expected by the end of Year 1 after adolescents participating in programme ) going community sensitisations

2.2 Increase in reported positive health behaviours by young people Project activities are on Impact and results will be seen in (e.g. increase in reported condom use during last sexual encounter going year 3 ET – this is referred to in the next page – can we not add the 49 refereed to their? 2.3 Reduction in the proportion of adolescents girls who have Project activities are on Impact and results will be seen in unplanned pregnancy by the end of the project going year 3

Objective 3: Outcome Level 3.1 Increase in availability of integrated Youth Friendly Services in Project activities are on Expected by the end of Year 1 health facilities going

3.2 Increase health care providers who are more responsive to Project activities are on Expected by the end of Year 1 adolescent needs going

. 3.3 Increase in utilisation of health services by young people Project activities are on Expected by the end of Year 2

16 Progress against all indicators within log frame Number: Total number: Comments Current reporting period Programme to date going Objective 1: Output Level Number and type of stakeholders involved in advocacy and lobbying The community members and peer at district and community level educators are already engaged in this process, further analysis to be held at the end of Year 1 Number of community meetings held 12 12 community meetings have been held so far with peer educators and drama groups Number and type of campaigns conducted 4 Awareness raising activities have been carried out in 3 international celebration days and the Plan 75th anniversary event Number and type of community leaders/parents supportive for health To be measured at the end of Year 1 for young people Objective 2: Output Level Number of adolescents (males and females) trained as peer 21 21 Youths (11 females and 10 Males) educators

Number of adolescents reached by peer educators To date, community sensitisations have reached 1,024. Project team completing beneficiary mapping exercise to finalise counting strategy of direct beneficiaries Number of schools with active school health clubs and mentorship This will be measured by the end of programmes. year 1

Number and type of action groups in the community/district. Most groups will have been formed in Year 2 Number of outreach activities conducted in the communities 12 Up to date they have done up to 12 activities Objective 3: Output Level Number of adolescents accessing youth friendly health services This will be measured at the end of Year 1 Number and type of health services offered by health facilities Reproductive Health Information and (including mobile) Services including Family Planning for young people, Screaning and treatment of Sexually transmitted infections(STIs),growth monitoring for

17 Progress against all indicators within log frame Number: Total number: Comments Current reporting period Programme to date under 5 children, antenatal and post natal care clinic for young mothers etc, Number of trained health providers providing youth friendly services 12 (3 females and 9 males)

Number of referrals received for health services This will be measured at the end of Year 1 Number of youth friendly corners established 4 One in each clinic of the four communities targeted in the initial phase

18 Annex Two Progresss against Activity Plan

Key Activity Description Variance Comment 1 Stakeholder mapping A stakeholder mapping exercise was held to This is a continuous Although the main activity is identify clinics, schools and relevant process as new CBO and completed, community mapping will stakeholders in the project implementation NGOs are being formed continue throughout the process as area. and come to conduct new CBOs and NGOs may become related activities in the active in the project areas. With the communities. additional community to be reached from next quarter, the activity will be revisited to establish the presence of other organisations present in the area 2 Baseline study The Baseline was conducted through the Data collection The draft baseline report was implementing partners PPAZ. completed, final report completed and Plan has been has been delayed. working with the consultant and PPAZ since then to resolve some of the outstanding issues. We expect to share highlights of the baseline in June and additional information will be collected in the future through the advocacy research piece. 3 Stakeholder and A start up workshop was held in October Completed Participants in the workshop included Partner sensitisation 2011. representatives from the district meeting/start-up education and health authorities, workshop staff from Plan Zambia and Plan UK, PPAZ staff and the baseline consultant. Objectives of the workshop were: 1. To share information and increase understanding of the YHP. 2. To increase awareness of the situation on young people’s health through the baseline and other sources 3. To build ownership among participants to implement and monitor programme 4. To introduce work planning

19 Key Activity Description Variance Comment and initiate activities 5. To establish and strengthen relationship between all the stakeholders implementing the programme

1.1 Developing Initial discussions have been held about the Planned for next quarter The advocacy strategy is being community advocacy advocacy strategy between Plan and PPAZ developed with the help of the strategy on health but this has not yet been developed to a more Advocacy and Gender Coordinator at rights of young formal strategy to inform engagement with the Country Office people stakeholders.

1.2 Training of drama These drama groups will tackle many issues Ongoing One training was carried out for groups for pertaining to cultural and traditional practices drama group members from the four community hindering young people’s health and will aim initial communities targeted. They mobilization on key to increase awareness and instigate action in were equipped with attire and drums. health issues their respective communities. Additional members will be trained when the project extends to the additional communities. 1.3 Training of parents, A training was delivered in March 2012 for Ongoing The Topics covered during this teachers and Parent and community elder Educators. The training were; An adolescent today community initiators training was attended by Parents, Initiation and the challenges, Young People on young health advisors, teachers and Area development and SRH Reproductive Health and issues. committee chairperson from the four targeted Rights, Youth Friendly Health areas of Chadiza district. With supervision Services, Sexually Transmitted from PPAZ, by the end participants had Infections, Gender Based Violence, prepared work plans to follow up on their Contraception and Teenage learning. Pregnancy, Termination of Pregnancy Act of 1972, Behaviour Change Communication, Counselling Skills with youth, Introduction to HIV/AIDS, Conflict Management Conflict Management, Male circumcision

1.4 Raising awareness The project participated in the Ongoing The drama group from Zemba RHC and organizing commemoration of a number of international was invited to participate at the 75th community advocacy celebration days including World AIDS Day in Anniversary celebration of Plan meetings through December 2011, World TB day and Youth International to entertain guests and

20 Key Activity Description Variance Comment community action Day. the entertainment mainly featured days or international SRH messages; days e.g. Day of the African Child, World AIDS day,

2.1 Peer educator Peer Education training was carried out in Ongoing Topics included HIV/AIDs, training November 2011 with 21 participants from the prevention of STIs, family planning, four communities. rights, avoiding pregnancy, how to communicate messages to others.

2.2 Adapt & distribute Materials were adapted and collated to be Once printed, this will be distributed IEC/BCC materials used as a handbook for Peer Educators Ongoing to Peer Educators to support them to implement sensitisations

2.3 Community radio Training was carried out for Peer Educators Ongoing. The process of For the radio training, 12 Peer programme in in radio programming and presentations. signing a contract with Educators (6 males and 6 females) Personnel from various media houses were one of the media houses from the four project sites were also orientated on the aims and delivery of is in progress. Radio trained along with the PPAZ Project the Young Health Programme. programmes will begin in Coordinator. The purpose of the July 2012. training was to see how the media houses and the project in Chadiza could work together. 12 media personnel from various media houses were oriented. The media personnel will be helping peer educators to conduct radio programmes on SRH; The programmes will be 30% in English and 70% in local languages. The format will vary across programmes – some will be live on air so listeners are able to call in and participate in discussions, others will be pre-recorded.

2.4 Conduct outreach Community outreach activities have been Ongoing Community outreach activities activities carried out jointly by Peer Educators and included drama performances, Drama group members to raise awareness of guided discussions and the issues around adolescent health, provoke opportunity for individual

21 Key Activity Description Variance Comment discussion and provide a forum for young consultations. Condoms were also people to access individual guidance. distributed to young people in the area. Peer Educators also participated in a traditional ceremony in Chipata accompanied by health staff from John Farm Rural Health clinic and three elders. 2.5 Girls groups Delayed until next period This activity was delayed until after other activities had been completed. The project is now in the process of identifying young people to participate in the groups. 2.6 Boys groups Delayed until next period As above

2.7 Monthly YAM One meeting was conducted Ongoing The first YAM meeting was held at meetings the beginning of March at the Youth corner at Chadiza urban clinic. The meeting was attended and delivered by the youth action group members for Chadiza district. The meetings are intended to take place on a monthly basis.

3.1 Adapt service This is under development Ongoing The manual will be used to support provider manual for the trained health workers. youth friendly health services 3.2 Service provider One training was carried out for service Ongoing This training was a three day training training for youth providers in the provision of Youth-friendly for service providers from the four friendly health services. clinics of the YHP targeted areas. services. Other participants included the traditional healers and community- based distributors of contraceptives. The topics covered were: An adolescent today and the challenges,

22 Key Activity Description Variance Comment Young People and SRH Reproductive Health and Rights, Youth Friendly Health Services, Sexually Transmitted Infections, Gender Based Violence, Standards For Youth Friendly Health Services, Termination of Pregnancy Act of 1972, Behaviour Change Communication, Behaviour Change Communication, Counselling Skills with youth and contraceptive and family planning. Strengthening of A youth friendly corner was set up in each of Ongoing Clinics in extension communities will 3.3 Youth services at the four clinics. also receive youth-friendly corners clinics through later in the community. Zemba setting up youth community’s YFC will be re- friendly services and established once the roof of the clinic providing necessary is fixed. equipment. Thirteen youth counsellors were trained in Ongoing Of the thirteen counsellors trained, 7 youth friendly health service provision. were female. The three day training was held 18th March 2012 to 20th March 2012 and covered the same topics as the service providers. One 3.4 Training of Youth challenge experienced during the Counsellors training was the higher than anticipated translation requirements between English and local languages which caused the sessions to overrun. Quality of Care committees were established Ongoing Committees aimed to recruit 10-15 Establish Health in each of the four targeted communities members in each community to play 3.5 Centre Advisory a role in assessing and monitoring Committees the quality of services provided by the health clinic. Meetings are intended to be held on a quarterly basis.

Quarterly Review A review was carried out as part of the start- Delayed until next quarter The regular review meetings will start Meetings up workshop in October, but since then as the in June 2012.

23 Key Activity Description Variance Comment programme has commenced with an intense period of activity to launch different activities, there has not been a formal review meeting. Annual Review Planned to take place in Will take place after the completion Meetings July 2012 of Year 1 activities End line Survey Planned to take place in Will take place at the end of the 2014 project

24 Annex Three Global Measures

This table will be completed during the annual report in September 2012.

Outputs Number Total Outcomes When -current number- outcome reporting programme measure period to date expected Total number of young people who have received health Examples might be: Likely to be information through AZ YHP Yr 3 for % increase in knowledge of adolescents on outcomes Number of young people who received information health issues about: a. Sexual and reproduction health % decrease in myths/misconceptions amongst b. Mental health and emotional well-being adolescents on various health issues c. Substance abuse d. Violence Improved access and services to address health e. Nutrition needs of young people evidenced by: f. Infectious diseases % increase in young people accessing services g. Accidents/injury from health clinics/counseling services h. Other health issue i. Access to healthcare Increased engagement of influencers in relevant Number of young people directly trained in delivery of committees/groups/activities eg workshop interventions attendance

Total number of frontline health providers who Increased support from community leadership successfully complete training programmes in for health interventions for young people adolescent health Number of referrals made eg by HIC and peer educators, counsellors, teachers Total number of influencers (parents, teachers, and leaders) reached by programme

Estimated population reached via awareness raising/media campaigns