Reaching Out to Youth: Youth-Friendly Sexual and Reproductive Health Services Through Schools, Clinics, and Communities

This 8-page case study describes the implementation and impact of an initiative to increase young people's access to accurate information about their sexual health and reproductive lives in the Navoi oblast of Uzbekistan. By creating a triangular support structure composed of clinics, schools, and communities, the international organisation Project HOPE worked to integrate family planning into its child survival project (2003-2007). With funding from the United States Agency for International Development (USAID), Project HOPE provided training, materials and guidance; helped the health system develop service protocols; and helped the education system create curricula.

As detailed here, a core tenet of the initiative was that sexual and reproductive health (SRH) should be understood and approached as a normal, necessary topic for young people. To facilitate the creation of youth-friendly services and education grounded in this tenet, Project HOPE developed linkages among clinics, schools, and communities - working with the ministry of health (MOH) to establish youth-friendly service protocols. It also provided training to health workers and to education workers. Outside the health system, those who had been trained reached out to makhallas (local communities) in Navoi oblast. For example, because some parents opposed their children's exposure to SRH information, particularly in the more culturally traditional areas, Project HOPE turned to makhalla leaders to garner the support of parents and adults for the topic in schools and for services in youth-friendly clinics. In part, they did so by distributing a booklet designed for parents called "If There Is a Teenager in Your House;" 20,000 copies were printed and disseminated.

Young people also got involved: Project HOPE initially held several 2-day SRH education sessions for youth. During these training sessions, the project chose the most promising students to participate in the peer educators' course. They then went on to offer information and advice in groups and one-on-one sessions in homes, coffee shops, discos, at soccer matches, and wherever young people were likely to gather. Young people were amongst those Project HOPE consulted in developing its series of information, education, and communication (IEC) products. They included posters and informational brochures on topics like high-risk behaviour, prevention/signs of sexually transmitted infections (STIs), and modes of HIV/AIDS transmission. In addition, short films premiered at a special event for adolescents (held at the Palace of Culture), were shown on Navoi oblast's television network, and were used in schools and clinics.

The peer educators also helped teachers and school nurses/doctors offer the SRH curriculum in the classroom. According to organisers, "[t]heir participation put their fellow students at ease. As a result, students were more likely to listen, ask questions, and treat the topic seriously." The young leaders also participated in strengthening service provision at youth-friendly clinics. For instance, they held club meetings to discuss their plans, progress, and problems. (They also obtained further technical advice, as needed, from the health care providers during these meetings.) Peer educators were actively involved in the Navoi clinic, which was well advertised in leaflets and on T-shirts. Up to 20 peer educators were available on Mondays, and supported various educational activities the centre carried out in different locations. A local non-governmental organisation (NGO) also used the peer educators in its educational events.

Through these strategies, Project HOPE reached out to more than 25,000 teens via 129 schools, 126 neighbourhoods, 2 new youth-friendly clinics, and 3 youth-friendly rooms within clinics in 5 pilot sub districts. At baseline (February 2004), only 1.3% of youth surveyed knew when during her menstrual cycle a woman was most likely to become pregnant; the June 2007 evaluation showed that this percentage had increased to 35.3%. At baseline, 30% could name 3 or more contraceptive methods, whereas 83% could do so at the end of the project. Over 90% of youth could name 2 or more mechanisms of HIV transmission by the conclusion of the project, in contrast to 44% of those at baseline. The percentage of youth who could name 2 or more ways to protect themselves from STIs increased from 16.7% to 80.3%.

The MOH used the materials and methods piloted in the pilot clinics, schools, and makhallas of Navoi to replicate the activities of Project HOPE in non-pilot rayons (subdistricts) of Navoi oblast and in Surhandarya oblast.