Umoyo Wama Youth Project

Umoyo Wama Youth Project

Young Health Programme – Zambia

Photo Credit: Plan/Petterik Wiggers

Eighteen Month Report July –December 2012

In collaboration with AstraZeneca and Planned Parenthood Association of Zambia

AstraZeneca – Young Health Programme (Zambia)

18 month report

July2012 – December 2012

Project name: / AstraZeneca Young Health Programme Zambia: Umoyo Wama Youth Project
Project location: / Ninecommunities of Chadiza Programme Unit, Eastern Province, Zambia
Project duration: / Three Year Project (July 2011 – June 2014)
Targeted Beneficiaries / The focus of Young Health Programme in Zambia is on adolescents of Chadiza District in the Eastern and Central Provinces. Chadiza is a remote rural area with traditional cultural practices that are associated with a high prevalence of early marriage and early pregnancy.
Direct beneficiaries: 12,500 direct young people (7,500 girls and 5,000 boys) between the ages of 10 – 24 years in Chadiza.
Indirect beneficiaries:44,815 in total. 25,000 people comprising women, men, girls and boys in the general Chadiza population and 19,815 people through advocacy both at the district and national levels.

Outcomes

/ Goals and Objectives
Goal: To improve the health and well-being of adolescents in Chadiza District in Eastern Province of Zambia.
Objectives:

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

New Boundaries
In 2012 the new Government of the Republic of Zambia decided to redraw some of the district boundary lines and create a number of new districts with the aim of enabling people to access basic needs (eg education and health facilities) more easily within their localities. One of the nine Chadiza communities targeted by the YHP named Vubwi community, now falls within a newly created district called Vubwi District. The YHP is continuing to work with all nine communities as originally planned even though now one of them is no longer part of Chadiza. Due to the strong links already established with the local community leaders on the ground, this means there is little impact on the project activities, other than that we have also now been additionally establishing a relationship with the New District Commissioner in the area.
Objective One:To mobilize community support and increase advocacy for improved access and quality of young people’s health services.
During Year One, the YHP in Zambia focussed activities on four of the nine targeted communities (Nsadzu, Madzaela, Zembaand John). During Year Two, the project has extended its focus into the remaining five communities (Sinalo, Chikoma, Chanjowe, Miti and Tefelansoni). Building on the survey carried out across all communities at the start of the programme, a stakeholder mapping exercise was conducted to provide a detailed and up to date picture of the new areas targeted and to generate awareness among key stakeholders of the forthcoming project activities. The five communities were visited and meetings organised with the community representatives and health centre staff to introduce the project and find out if any there were community based organisations in the area engaging in similar activities. The district partners such as the District Commissioner, Education and Health authorities were also informed of the expansion of the project to the new areas.This was done in order to provide information on the project, increase the understanding of the YHP, introduce the work / activity plan for the selected new sites and establish and strengthen relationships between all the stakeholders implementing the programme.The project team visited the health facilities and schools where the activities were to be carried out. The project team also provided guidelines to the communities on selection processes for specific target groups who would be participating in project activities such as Peer Educators, youth counsellors, traditional healers, parents/elders, drama members, traditional leaders and teachers. The actual selection of the participants was conducted by the health centre staff and the community members through the Neighbourhood Health Committees (NHCs). This was done to encourage the participation of the targeted communities and promote sustainability of the project. Training programmes are planned for a number of these target groups in the second half of Year Two (mainly between April and July 2013).
One of the most significant activities around mobilising community support for youth health issues was through activities that took place to commemorate the 2012 World Aids Day which took place on 1st December. The programme engaged YHP youths, community leaders and service providers to support activities on the day. YHP Peer Educators used the opportunity to disseminate information on adolescent SRH issues to a large number of people from surrounding communities through drama, sketches, and dances. The main theme of the day was focussing the importance of visiting a health centre for voluntary counselling and testing (VCT) for HIV/AIDS which was identified as a key health issue.
During Year One, the programme developed an advocacy strategy which outlines how communities can raise awareness and influence others on important issues. During Year Two, communities have started discussions with traditional initiators aroundpostponing the initiationceremonies. Key to this discussion is building the initiators knowledge of the negative health issues that these ceremonies can lead to. The advocacy messages promoted have been that a girls first period should not be the trigger of initiation, instead an opportunity to focus on providing them with information about hygiene and personal health. Also that community’s should not rush their daughters into early marriage, but instead initiate them later when they are older and have finished school. The reaction from the initiators has been so far very positive, many of them reporting that they have felt empowered by being able to give important information to their communities. Behaviour change of this nature is a gradual process, and the programme will seek to measure the impact of these messages in Year Three.
The Young Health Programme has continued to work with community development committees established in four communities during Year One who have participated in meetings to help identify key community issues and supported community sensitisations. During the second half of the year, five new committees will be established in the newly reached communities.
The project has built strong links with local government authorities, working especially with the health and education departments. Their support has been a crucial element in community mobilisation, engaging local chiefs to support the project messages and successfully securing communities to participate in sensitisation activities. Support of these departments has also been crucial for enabling the project to work directly with local health facilities and schools.
Objective Two: To promote information sharing, education and communication for adolescents on relevant health issues.
The project continued to sensitize the communities and share information with the young people on reproductive health issues that affect themthrough a variety of approaches, including the use of Youth Friendly Corners (see more under Objective 3).
Over the last six months the project has trained an additional 34 new Peer Educators from the five new communities (so a total of 55 Peer Educators trained to date across the project). The peer education training took place in October and lasted for 10 days. Young people were selected as participants with support from staff of the local health centres, the NHC’s and community members. The training covered a range of topics relevant to adolescent health including basic anatomy and physiology, family planning, teenage pregnancy, STI’s, HIV and AIDS, abortion, drug and alcohol abuse, and youth-friendly health services. The training also looked at wider related issues such as self-awareness, being an adolescent today, sexuality and diversity, relationships, sexual rights, gender-based violence, stigma and discrimination, behaviour change communication, leadership skills, community mobilisation, facilitation, and counselling skills. The training was very participatory, involving lectures, group work and question and answer sessions. The training not only built the capacity of young people to become Peer Educators in the field of adolescent health, but also supported them to develop work plans for outreach activities in their own communities.
In addition, 20 new drama group members were trained (36 in total to date).The training which took place in November lasted for five days and built the capacity of young people to support peer education outreach through the medium of drama and performance. Among the topics covered were content generation (eg training on HIV and AIDS), scriptwriting and communication through songs.
During the six month period, Peer Educators and drama members conducted 55 community sensitisationmeetings, mostly in the earlier four communities targeted in the first year. In each community the YHP youths played drums to mobilise a public audience and thereafter performed a drama related to one or more of the selected topics which include HIV/STI transmission, prevention and risk factors, early marriages, early pregnancy and unsafe abortions. Following the performances, Peer Educators held question and answer sessions that encouraged the audience to discuss various issues of concern.The Peer Educators used a variety of strategies depending on the situation, for example more sensitive issues would sometimes be discussed through small counselling group approaches. In cases where an individual identified a condition or need for further support, the Peer Educators referred them on to local health centre where service provider staff could help them. This community sensitisation work has led to an increase in the numbers of adolescents accessing services from health facilities (data from health centre registers will be measured for the annual report).

The Peer Educators receiveongoing support from project staff who meet regularly with them to provide guidance and encouragement.Youth Action Movement (YAM) meetings were held twice during the last six months and brought groups of Peer Educators together to discuss experiences, challenges and share learning about what approaches are successful when carrying out community sensitisations. The Peer Educators are also supported by staff from the local health facilities who provide technical information, supplies (e.g. condoms) and deal with referral cases identified.
In Year One YHP worked with the ‘Feel Free’ radio station and 26 programmes were recorded and aired. Building on the success of activities in Year One, the YHP signed a contract with a new station, Mpangwe community radio station to record, produce and air 52 radio programmes. The radio station was selected for its wide catchment population of about 850,000 people across Chadiza, and neighbouring districts, of whom an estimated 435,000 are youths.The recording is ongoing in the communities and so far 25 programmes have been recorded. The programmes involve youths, health service providers, traditional initiators and community leaders who discuss issues affecting young people in their communities and the current interventions of the YHP. Adolescents are selected to participate by community representatives and Plan’s Community Development Facilitators. For particularly sensitive cultural and traditional issues, the programmes have engaged community leaders and elders who are the custodians of the customs, to lead these discussions. It is a powerful tool for young people to hear parents and community leaders discussing and standing together with them on issues of adolescent health. The topics include;initiation ceremonies and the effect they have on the health and education of young boys and girls and how they contribute to early pregnancies and marriages, STIs and HIV/AIDS and the community perception of the pandemic, youth-friendly corner services available at health facilities and how young people can access these services. In addition to broadcasting the recorded show, the YHP is also planning live programmes where adolescents will conduct interviews on air to encourage young people to call in and interact.
Messages by the parents on air include: Messages by Peer Educators on air include:





The Programme has continued to support the four schools running school health clubs which were established in Year One. The clubs meet on a weekly basis, supported by a teacher who was trained by the YHP. The groups discuss issues such as HIV and prevention, and play a lead role when the schools engage in health activities. The school health clubs and Peer Educators each have played key roles in leading and organising Insaka meetings when people come together to focus on a specific issue. Depending on the issue this may be held in single sex groups, or mixed. Meetings so far have concentrated on topics such as hygiene, prevention of teenage pregnancy and respect for each other. Over the last six months, six such Insaka meetings have been held.
Objective three: To strengthen and improve the existing health services to provide quality youth friendly health services.
During the first year of the programme, the YHP trained health workers and youth counsellors who are based in the health centres in the first four targeted communities on making services more accessible to young people. The combination of this and the demand created through community sensitisations has seen an increase in the number of adolescents accessing health services through the facilities. The service provided include screening and treatment of STIs, youth counselling for VCT and HIV/AIDS, targeted reproductive health information, distribution of condoms and counselling on abortion -related issues. The training provided to the health centre staff has helped them in being able to discuss issues such as unsafe abortions with young people, which were prevously not discussed in the open. The staff also deal with young people referred to them by Peer Educators for specific individual counselling, supplies or services. During the period reported, 820 young people accessed services through the health centres.

Youth Friendly Corners(YFCs) have been established in all the nine health centres (one per community) to encourage young people to visit and feel comfortable at the health facilities, and also as a way of reaching them with health information. The four communities targeted in Year One now have YFCs that are fully functional and equipped with furniture (benches, tables, chairs) and board games for recreation activities that attract young people to the health centres. The three YFCs that have been provided with pool tables have been particularly popular. The other five YFCs will be furnished during the second half of the year. Through the YFCs, young people can access SRH information, ask Peer Educators questions, and be referred to health staff immediately if the Peer Educator does not have all the information. The Peer Educators use the YFCs to distribute information on SRH issues and facilitate discussions on health issues such as the transmission, prevention and control of STI’s, including HIV.
Progress against indicators / Please see Annex 1 Progress against logframe indicators
Global Indicators / Please see Annex 4Global Indicators
Project activities: / Please see Annex 2Progress against activity plan
Project challenges: / One of the main challenges facing the Peer Educators remains transport and logistics of carrying out outreach activities. The YHP has mitigated this to some extent by encouraging Peer Educators to focus mainly on activities within their own communities. However many of the communities are very large and scattered across a large geographical area, so even this creates challenges in terms of distance and fatigue. In order to tackle this issue, the programme is piloting a new approach in one community (Madzeala) where the Peer Educators from that community have divided into sub groups, with each sub group focusing on peer education within a specific zone of the community. They then come back together once a month to meet at the YFC in the health centre to report back and share experiences. So far, this model is working well and is likely to be rolled out in other communities.
Another challenge is the retention of trained Peer Educators. So far, the programme has lost three of the trained Peer Educators, two moved out of the community to go to college, and one left the area to get married. To ensure continuity and sustainability of the intervention, the project is continuing to recruit and train new young people to replace those who have left. The YHP has also continued contact with the two young people who have gone to college, to see how they can be linked to health initatives in their new location, so they can continue to expand the impact of the programme.
A futher challenge is that many of the health centres have restricted space and it has been difficult in some cases to secure space for the YFCs. Four of the YFCs are sharing the space with other groups/activities. But one recent positive development is that two of the centres are receiving an extension to their facilities from the government, and the strong relationship the YHP has formed with the centre staff is helping us to push for some of the additional space to go to the YFCs.
Sustainability / The YHP has adopted various strategies and approaches to ensure ownership and sustainability of the project. The project ensures full participation of key stakeholders, including local authorities, local community leaders, parents, chiefs, community members and young people from the target communities.
The recently held stakeholdermapping meetings were aimed at ensuring that partners are involved so that sustainability becomes less of a challenge in the project. The project has continued working with multiple government stakeholders including health centre staff, the Ministry of Health and Ministry of Education, and the teaching staff at local schools.
Project management, monitoring and evaluation: / The project is being monitored at community level by the PPAZ project coordinator who sends information to the health coordinator. PPAZ has employed an M&E officer who will also be providing support to the project in data collection and reporting.
The Plan Health Coordinator is based in the Programme Unit office in Chipata and works together with PPAZ and the nine CDFs resident in each of the target communities. He receives technical support from the Health Programme Manager based in the Plan Country Office in Lusaka.

PPAZ and Plan continue to jointly oversee the project implementation, supervision and monitoring. The project team facilitate the implementation of the activities, regular monitoring, monthly and quarterly reports.
Project impact is also monitored by the project team against the indicators in the project log frame. The PPAZ Programme Manager and M&E Officer provide technical support for implementation and monitoring of activities.
Budget: / See Annex 3 Financial Report
Photos: /
Trainee Peer Educators working in groups during the training in October 2012

A youth demonstrating how to use a female condom during Peer Educator training and an adolescent presenting a poem during the 2012 World AIDS Day

Drama performance by the youths during the commemoration of the 2012 World AIDS Day in Vubwi District
PROJECT QUOTES / “Before the onset of the project, I was a person who was very behind in terms of sexual reproductive health issues. Now after working with my fellow youths on the YHP and the SRHR information that I have acquired my mind has been opened I am now knowledgeable on issues to do with STIs and HIV. When I was found with an STI three months ago, it was a bad experience, now because of the information I acquired from being involved in the project, I went to the clinic and I was given medication without delay, so I know how to share what I have learnt with my fellow youths and encourage them to visit the health centre each time they experience SRH problems. This change has also been scaled up to the communities, youths are now free, they are now open to come to the health centre explain their sexual health problems to the health centre because of the awareness created by the YHP”.
Masau Mwanza, 25 years, Peer Educator
“I have benefited a lot from the YHP because before I ignored a lot of things especially issues to do with SRH, but immediately after the training and the interactions I have had with my fellows members and Peer Educators I have learnt a lot about different STIs issues, teenage pregnancies, the importance of going for VCT and transmission of HIV”.
Mwazi Kumwenda, 26 years,Parent/Counsellor
“I really thank the YHP for according me this opportunity to be part of this programme which is life serving, and in the community there is positive behaviour change and I have come to know the dangers of teenage and unwanted pregnancies and prevention methods of STIs and HIV”.
Mailesi Zulu, 21 years, Youth Counsellor, Madzaela Health Post, Chadiza
“Parents should allow their children to go to school and not let them get married early because education is important”.
Stanley, 23 years,Peer Educator, Sinalo
“As parents, we have to protect our children by not letting them get involved in early sex and marriage”.
Mailika, Parent, Zemba

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