Formative Research on Youth Peer Education Program Productivity and Sustainability

"Youth peer education (YPE) is a widely used approach to reproductive health promotion and HIV prevention, and the number of YPE programs globally continues to grow. However, donors, policy-makers, and programmers have few tools for assessing both the programmatic impact and the cost-effectiveness of YPE programs (i.e., 'what works and what does not,' as well as 'why or why not')..."

This 64-page contribution to Family Health International (FHI)'s Youth Research Working Paper Series discusses the first phase of a two-part study of the YPE strategy, which Family Health International (FHI)/YouthNet conducted in Zambia and the Dominican Republic. The study had the following objectives:

• to identify core elements of programmes through an examination of both quantitative data (about programme activities, costs, and outputs) and qualitative data (gathered through 70 interviews and 21 focus group discussions, or FGDs). These programmes focus on issues such as HIV/AIDS, sexually transmitted infections (STIs), sexual and reproductive health and rights - and the promotion of youth-friendly services and strategies to address these issues.
• based on these core elements, to develop frameworks and tools (e.g., checklists) to assess YPE effectiveness and sustainability.

To meet these objectives, researchers carried out a descriptive, process evaluation over a period of 18 months to examine 4 community-based programmes in Zambia and the Dominican Republic, as follows:

1. La Asociación Dominicana Pro Bienestar de la Familia (ProFamilia), Santo Domingo,
   Dominican Republic - "Expansion of Reproductive Health Programs for Adolescents Using Peer Education Strategies" operates in marginalised neighbourhoods, or barrios, in the capital city of Santo Domingo. The project has selected and trained 240 peer educators, who work in the geographical areas where they and their families reside. Once trained, they meet weekly or every 15 days with their direct beneficiaries to teach one or two topics from the manual Hablemos. Indirect beneficiaries include youth who are reached informally on the street, at school, or at a social event.
2. Asociación Dominicana de Planificación Familiar, Inc. (ADOPLAFAM), Santo Domingo,
   Dominican Republic - In the semi-urban barrios of Lava Pie and Madre Vieja in San Cristóbal, peer educators systematically educate a group of direct beneficiaries and non-systematically educate indirect beneficiaries who are often encountered via local schools. The main programme strategy is interpersonal communication via peer educators, who lead a diverse number of activities with youth, parents, teachers, and community leaders such as talks, lectures, home visits, face-to-face meetings, recreational activities, socio-dramas, theatrical presentations, and running/jogging activities. The programme also uses local media channels, posters, videos, pamphlets, and participation in events such as World AIDS Day and mass sports events.
3. YWCA-Lusaka Peer Education Program, Lusaka, Zambia - Approximately 30 peer educators who have been in the programme 3 to 7 years use focus group discussions, dramas, one-on-one counseling, sensitisation and awareness programmes, videos, debates, quizzes, local radio and television programs, and printed materials. They also work at two clinic sites providing referrals for youth at youth-friendly corners.
4. SEPO Center, Livingstone District Health Management Team, Livingstone, Zambia - About 20 "super peer educators" recruit and work with other peer educators in the zones (in theory, at least 20 others in each zone). The peer educators use one-on-one dialogue, group counseling, and drama, as well as distribution of brochures, pamphlets, and condoms.

Based on the specific data that is shared within this report about these 4 programmes, evaluators have developed frameworks and 8 separate checklists to use in assessing YPE effectiveness and sustainability; they are detailed in the Appendices of the report, and include:

• Checklist 1. Technical Frameworks
• Checklist 2. Stakeholder Cooperation
• Checklist 3. Parental Involvement
• Checklist 4. Youth-Adult Partnerships
• Checklist 5. Youth Involvement
• Checklist 6. Peer Education Cooperation
• Checklist 7. Gender Equity and Equality
• Checklist 8. Community Involvement

In general, "The study found YPE programs to be people-intensive and dependent upon cooperation among many actors and institutions. The 'work force' is composed primarily of youth volunteers who can join and leave a program with little obligation. Their retention, motivation, and productivity are critical to a program's success..." Specifically, the study revealed the following 6 primary core components of YPE that contribute to a programme's success and sustainability:

1. Youth involvement is critical for peer educator retention, motivation, and productivity. - The degree of empowerment that youth develop through the help of adults in the programme can be supported with adequate training and supervision so as to increase peer educators' decision-making skills and proficiency in carrying out their responsibilities. The study also found that gender equity and equality, as well as cooperation within the peer educator groups, were critical for motivating and retaining peer educators.
2. Community participation and support is critical to programme sustainability and productivity. - This element increases the motivation of youth peer educators and parents, as well as the responsiveness of the programme to the group it is addressing. It also improves access to community institutions and their youth audiences and can even sustain a program though economic hardship. In addition, the study found YPE to be both a result and a method of community mobilisation.
3. YPE programmes need sound technical frameworks, especially in regard to adequate training and supervision, that meet the special demands of youth and adolescent volunteers. YPE technical frameworks should integrate youth involvement, youth-adult partnerships, and gender equity and equality into their planning and strategies.
4. Successful youth-adult partnerships are critical in developing positive youth dynamics. These partnerships require direct youth involvement, open communication, trustworthiness, mutual respect, reciprocity, and adult support/facilitation.
5. Trained youth peer educators contribute to civil society by virtue of their citizenship and their long-term leadership, but this potential resource is often under-realised once they age-out of YPE programmes. Few policies or programs exist to harness peer educators' valuable skills and leadership once they leave YPE programmes. Policy-makers should consider strategies that would allow YPE to become systemically integrated into youth policies at all levels.
6. There are considerable variations between YPE programmes in terms of the number of activities carried out, type of participants, nature of the contacts, locales, topics covered, and costs.