During an IEC strategy and project implementation workshop organised in November 1995 to launch the project, Messrs. Jason Onsembe and Opia Mensah Kumah, the CSTAA Advisors for Survey Method and Sampling and IEC Organisation and Management respectively guided local consultants from the Demographic Training Unit (DTU) of the University of Dar es Salaam and project management staff to design a research and evaluation plan that spelt out methodologies, data processing and analysis procedures and a format for reporting the results. An important aspect of the research and evaluation plan was the development of key indicators for each of the three main themes - water, women and health. Questionnaire design, data analysis and report writing were all conceived to be derived from the indicators. CSTAA adopted a multi-sectoral, multi-disciplinary approach to executing this comprehensive research and evaluation plan.

The research and evaluation plan called for a variety of methodologies to carry out each type of research.

For formative research, three studies - a literature review, focus group discussions and selected data from the baseline KAP survey - were conceived to provide the socio-cultural and media information necessary for message design and media strategy development.

For monitoring, two studies were set up: (i) periodic analysis of service statistics and administrative records, and (ii) a panel study using "satellite families" to monitor the effectiveness and impact of mass media messages, particularly through the radio soap opera, "Twende Na Wakati".

For impact evaluation, a baseline and post-intervention KAP survey was designed to provide a quantitative measure of the impact of project interventions.

From the CSTAA end, a three-person research and evaluation team comprising Messrs Kumah, Onsembe, and Ms. Mere Kisekka, Advisor in Socio-Cultural Research, was constituted to backstop the research and evaluation activities of the project. The IEC Advisor, who designed the project and oversees its overall technical backstopping, coordinated the design and implementation of the research plan. Mr. Onsembe assisted in designing the sampling frame, data collection and analysis for the baseline KAP survey, while Ms. Kisekka reviewed all data collection instruments to ensure that they were sensitive to socio-cultural and gender considerations. Ms. Mie Baek, National Programme Officer at UNFPA/Dar es Salaam, and Mr. John Millinga, Project Manager, coordinated all logistics and field support in Dar es Salaam and Shinyanga.

Conclusions and key lessons

Although the project is still ongoing and a formal evaluation has not yet been conducted, two key lessons may be derived from its design and implementation. The first is that, within a rural community where development activities are conceived holistically, reproductive health IEC programme can be so designed as to address gender concerns as well as related development issues, in this case water and sanitation and afforestation. Such a linkage need not necessarily compromise the reproductive health component; indeed it may enhance it by making the entire project more acceptable to community members.

The second lesson is that the implementation of the research and evaluation component of an IEC programme can benefit from specialist technical input by data and socio-cultural Advisors. In the past, too many IEC projects carried out research activities whose outputs were of questionable value because research professionals and specialists were not involved in design and implementation.

For purposes of programming youth are typically divided into in-school and out-of-school. Reproductive health programmes for youth are usually designed one or other of these two categories. Addressing youth in either situation presents peculiar challenges in sub-Saharan Africa. We present below two approaches employed in Eritrea and Kenya to reach out-of-school and in-school youth respectively.

Youth Centre in Eritrea

A major challenge to addressing the reproductive health needs of out-of-school adolescent is that, unlike their counterparts in schools, they are hard to reach unless they belong to certain organizational structures. The problems facing many of these young people include early and unprotected sexual relationships, unplanned and unwanted pregnancy, school drop-out, induced abortions, sexually transmitted diseases, prostitution, early marriages, early child bearing among unmarried adolescents, sexual harassment and abuse, drug and alcohol abuse.

In Eritrea, UNFPA and the National Union of Eritrean Youths (NUEYS) have responded to this problem through a three-year project entitled Reproductive Health Education and Counselling Services for Youth (ERI/96/PO1). NUEYS is a national NGO with 100,000 members throughout the country. The goal of the project is to promote awareness of reproductive health and responsible parenthood among the youth, and to assist in developing and strengthening national capacity for providing adolescent health services. The immediate objectives include:

As part of its contribution NUEYS converted one of its buildings which used to be a night club in Asmara into a youth centre for young people. This centre is the first of its kind in Eritrea. It has a training hall, a library, a consulting room for adolescent health services, including reproductive and sexual health and family planning services, two counselling rooms, and a room for routine laboratory work.

A NUEYS member who is a trained physician has been designated as the project manager and clinician. He works closely with Planned Parenthood Association of Eritrea (PPAE) and the Ministry of Health to ensure that the provision of services is in line with the Ministry's procedures and guidelines. A system for efficient referrals is being worked out. The counselling section has a trained counsellor and sessional clinical psychologist who visits the centre weekly. Medical and audio-visual equipment, computers, videos, books and games have been purchased.

In May 1996 a training of trainers workshop on adolescent sexual and reproductive health and counselling skills was held in the training hall of the youth centre. Participants included health workers from MOH, the Eritrean Red Cross, St. Mary's Psychiatric Hospital as well as NUEYS youth leaders from the regions. The main objective of the workshop was to train trainers who will conduct training in the regions. The two-week workshop, conducted with the technical guidance of CSTAA Adolescent Reproductive Health Adviser, was facilitated by experts from the Ministry of Health and the University of Asmara. Based on the WHO Adolescent Counselling Skills Manual, the training was divided into three sections. The first section covered the reproductive and general health issues related to the needs of adolescents in Eritrea, the second section covered the basic psychodynamics of counselling especially listening skills and the third section combined the reproductive health issues and the couselling skills in role play exercises to practice the skills taught. Video films on AIDS counselling and teenage pregnancy were shown.

Training materials are being translated into Tigrigna and other major languages for training in the regions. NUEYS hopes to establish similar youth centers in all the regions to meet the sexual and reproductive needs of youths.

Adolescent Counselling Training in Kenya

In Kenya, efforts to introduce population/family life education schools have been hampered by opposition from religious groups and other powerful social forces opposed to offering reproductive and sexuality education to students. To get around this barrier, UNFPA and the Ministry of Education have decided to try a new approach: introducing counselling skills using the issues of an adolescent reproductive health information and education through school teachers as focal persons for counselling services in the schools. For this purpose 30 primary school teachers were selected from all provinces to participate in a six-week course in guidance and counselling organized by the AMANI. Technical support was provided by the CSTAA Adolescent Reproductive Health Advisor.

A remarkable feature of the workshop was the methodology it employed. The workshop had three components; class work, field placement and assigned reading.

The class work

Four days of the first week were devoted to class work to ensure a good knowledge base before embarking on the field assignment. Thereafter, the first two days of each week were devoted to class work, followed by three days of supervised field work. The class work which was very participatory was based on the WHO counselling module which breaks each day's class work into three parts.

The mornings were devoted to issues such as child development, maturation, adolescent reproductive and sexual health with specific reference to the Kenya situation, drug and alcohol abuse, gender, sexual abuse and harassment, teenage prostitution, female genital mutilation (FGM), generational gap, helping parents understand adolescent development issues, school discipline, how to use alternative forms of discipline, stress management, etc. The presentations were enhanced by discussions and roleplay exercises.

The first half of the afternoons was devoted to the basic psychodynamics of counselling including the initial interview, micro-skills of listening and observing, counsellor's responsibility, confidentiality, privacy, duration and frequency of session, difficult moments in counseling, bringing counselling to a close, communication skills needed by parents, counselling adolescent with the family, conflict resolution, etc. Again presentations were very interactive and included modeling and a play by a psychodrama group.

The second half of the afternoon was devoted to roleplay exercises in triads. The case studies for the role play exercises comprised of issues that had been presented in the morning combined with the skills taught in the first half of the afternoon. In the roleplays, the three participants in each triad took turns to act as a counselor, counselee and an observer. Each day ended with a wrap-up, reading and field assignments.

Fieldwork

Before the commencement of the training, the Ministry of Education prepared fifteen schools in the Nairobi metropolis to be used for the field placement segment of the training. Arrangements were made for each school to accommodate two participants. The headmasters of the placement schools met with the participants before the fieldwork began to discuss the programme and expectations. The field assignments varied from week to week. These included :