Zimbabwe Promotion of Youth Responsibility Project [from Reaching Youth Worldwide]

Appeal to Youth with Friendly Centers and Services
Zimbabwe's Promotion of Youth Responsibility Project

Youth need access to accurate information and friendly services to make informed decisions and choices about their lives. Promoting healthy behavior and linking young people to appropriate services requires a multi-channel approach. An intensive six-month multimedia communication campaign in Zimbabwe, entitled the Promotion of Youth Responsibility Project (PYRP) [9] began in 1997. The objectives of the PYRP were to increase young people's knowledge of reproductive health issues and to encourage them to adopt behaviors that reduce the risk of becoming pregnant and contracting STIs/HIV/AIDS. The project encouraged abstinence for young people without prior sexual experience. For those already sexually active, the projected promoted condom use and a reduction in the number of sexual partners. To achieve its goals, the PYRP sought to:

• Increase awareness, knowledge, and positive attitudes about reproductive health among young people:
• Encourage young people to attend identified youth-friendly health service facilities: and
• Increase support among leaders, policy-makers, and parents for reproductive health services and communication directed toward young people.

The campaign took place in five sites (four rural areas and one city) and included eight major components: launch events, a radio programme, a telephone hotline, peer educators, dramas, posters, leaflets, and a newsletter. Training programmes for providers at designated youth-friendly clinics complemented the campaign.

To improve the quality and availability of reproductive health services for young people, Zimbabwe's National Family Planning Council (ZNFPC) designated 26 clinics in the campaign area as youth friendly. Using a new training and counseling manual, ZNFPC trained one family planning provider from each youth-friendly clinic in interpersonal communication and youth counseling skills during a one-week course. Upon return to their clinics, the providers trained their co-workers in youth counseling. During the campaign, peer educators, drama groups, and print material referred young people who needed reproductive health services to the youth-friendly clinics.

How it worked

PYRP's strength was in operating at many levels while addressing broad social and cultural issues. The programme built support for the intervention among parents, teachers, health care providers, and other community members and fought biases against young clients in the health care system. By doing so, it ensured that young people would find a sympathetic reception when they tried to discuss issues raised by the campaign or seek reproductive health services.

PYRP built community support for the intervention by decentralizing the management of the youth campaign to local action committees. Youth made up half of the committees. The focus of the committees was on young people taking responsibility and playing key roles. Committees had representation from local government and religious, educational, health, and business groups.

The mix of campaign activities and materials proved to be effective in reaching rural and urban audiences. Campaign launches, for example, proved especially popular during the slow farming season in rural areas where entertainment is limited.

Evaluation Results

METHODOLOGY: The evaluation applied a quasi-experimental design with baseline and follow-up surveys in both experimental and comparison groups, involving about 1,400 women and men aged 10 to 24 years. Data were collected in five campaign and two comparison sites. Logistic regression analyses were conducted to assess exposure to the campaign and its impact on knowledge, attitudes, and behavior while controlling for other variables.

Increased discussion of reproductive health issues with friends, relatives, and teachers was the most significant behavioral outcome of the campaign. Among respondents in campaign areas, 80 percent said they had talked with someone - friends (72 percent), siblings (48 percent), parents (44 percent), teachers (34 percent), and partners (24 percent). More than half of the respondents reported they had said "no" to sex as a result of the campaign (see Figure 1). The campaign's largest effect was on encouraging sexually experienced youth to stay with one partner.

Sexually experienced respondents with greater campaign exposure took significantly more health-related actions compared to those with limited campaign exposure. This finding indicated a does-response effect. For instance, 41 percent with greater campaign exposure took any health-related action compared to 10 percent with limited exposure: 20 percent with greater exposure remained with one sexual partner compared to 2 percent of respondents with limited exposure; and more than 10 percent with greater exposure began using condoms compared to 2 percent with limited campaign exposure (see Table 3).

The campaign built support from leaders, parents, and providers in the community and within the health care system for reproductive health interventions directed toward young people. This support has enabled training for peer educators, youth-friendly clinics, and the hotline to continue.

Awareness of contraceptive methods and knowledge of some reproductive health and HIV/AIDS issues increased significantly in campaign sites but not in comparison sites.

One strategy of the project was to address gender constraints in sexual behavior. The PYRP called on girls as well as boys to take charge of their lives by fostering the value of individual self-esteem. Unfortunately, there was virtually no change in either gender regarding the overriding attitude that is was the males' responsibility alone to make sexual decisions.

*p.05 **p.001.Note: Odds ratio from regression analysis controlled for respondents' age, sex, education,sexual experience, marital status, and urban-rural residence.

Source: JHU/CCP and ZNFPC Zimbabwe Youth Project Evaluation Follow-up