ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH by 76ppp7sb

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									REPRODUCTIVE AND
SEXUAL HEALTH OF
 ADOLESCENTS AND
          YOUTH




                PROGRAM
              GERAÇÃO BIZ




   Summary Progress Report
                     2006




                        Implementation:
         GOVERNMENT OF MOZAMBIQUE
           Ministry of Education and Culture
                Ministry of Youth and Sports
                          Ministry of Health
                  Civil Society Organizations


                                  Support:
                    Pathfinder International
          United Nations Fund for Population
                    Government of Denmark
                      Government of Norway
                      Government of Sweden


                          February 2007
                                 ACRONYMS



AIDS      Auto-Immune Deficiency Syndrome
AJOCRI    Association of Christian Youth
AMODEFA   Planned Parenthood Association of Mozambique
APROGE    Management Improvement Processes
ARV       Antiretroviral
AVIMAS    Association of Widows and Single Mothers
AYFS      Adolescent and Youth Friendly Services
BCC       Behavior Change Communication
CAPB      Knowledge, Attitudes, Practices and Behavior
CFPP      Training Center for Primary School Teachers
CIADAJ    Intersectorial Committee in Support to the Development of Adolescents and
          Youth
CNJ       National Youth Council
CNCS      National Council Against AIDS
DPEC      Provincial Direction of Education and Culture
FAIJ      Fund in Support to Youth Initiatives
FASE      Fund in Support to the Educational Sector
HIV       Human Immune-Deficiency Virus
IDS       Demographic Health Survey
IEC       Information, Education and Communication
IMAP      Institute of Basic Teaching
INDE      National Institute for Education Development
INJAD     National Survey on Adolescents and Youth
M&A       Monitoring and Evaluation
MEC       Ministry of Education and Culture
MDG       Millennium Development Goals
MISAU     Ministry of Health
MJD       Ministry of Youth and Sports
NPAA      National Program Against AIDS
PAC       Post-Abortion Care
PARPA     Plan of Action for the Reduction of Absolute Poverty
PEN       National HIV/AIDS Strategic Planning
PGB       Geração Biz Program
PTV       Prevention of Vertical Transmission
PVHS      People Living with HIV/AIDS
POSIDA    Operational Plan Against AIDS
RSH       Reproductive and Sexual Health
RSHAY     Reproductive and Sexual Health of Adolescent and Youth
STI       Sexually Transmitted Infections
UNFPA     United Nations Population Fund
UNGASS    United Nations General Assembly - Special Session
VCT       Voluntary Counseling and Testing




                                                                                      ii
                                                    CONTENTS




1. Executive Summary ................................................................................................... 4
2. PGB Background ....................................................................................................... 5
3. Report Framework ..................................................................................................... 5
   RESULT 1. POLICIES AND STRATEGIES ........................................................................ 5
       Policies and Strategies - Constraints and Lessons Learned ................................... 8
       Policies and Strategies - Main Challenges ............................................................. 8
   RESULT 2. NATIONAL RESPONSE IN SERVICE DELIVERY ............................................ 9
       Services Delivery - Constraints and Lessons Learned ......................................... 17
       Services Delivery - Main Challenges .................................................................. 18
   RESULT 3. INSTITUTIONAL CAPACITY ....................................................................... 18
       Institutional Capacity Building - Constraints and Lessons Learned .................... 23
   RESULT 4. MULTI-SECTORIAL RESPONSE ................................................................. 23
       Multi-sectorial response - Advances in the achievement of targets .................... 23
       Multi-sectorial constraint ..................................................................................... 24
       Main multi-sectorial challenges ........................................................................... 24
4. Project Expenditure ................................................................................................. 24




                                                                                                                        iii
    1. EXECUTIVE SUMMARY
    The Geração BIZ Program (PGB) is a multisectorial program for the promotion of Reproductive and
    Sexual Health and HIV/AIDS prevention among adolescents and youth aged 10-24 years old. It is
    implemented by the Ministry of Education and Culture, the Ministry of Health, their respective
    Provincial representations, as well as by civil society youth associations and organizations. It has the
    support of Pathfinder International and the United Nations Population Fund (UNFPA) and is
    financially supported by UNFPA and government bilateral cooperation agencies from Denmark
    (DANIDA), Norway (NORAD) and Sweden (SIDA).
    For 2006, an ambitious plan was designed, with strategic activities to be implemented in the areas of
    policy; provision of school-, community-, and clinic-based services; strengthening of institutional
    managerial capacity; and multisectorial co-ordination.
    Out of the 35 targets established for the year, 17 were fully achieved, 14 are in the process of being
    achieved, and 4 were not implemented. In reference to the total of 139 planned activities, 88 were fully
    executed, 24 partially executed, and the remaining 27 not executed. In general, those activities not
    executed are related to targets that have been excluded or re-planned for 2007.
    Targets and activities planned for the areas of RSHAY policies and strategies were satisfactorily
    implemented: 1) the process in the preparation for AYFS quality certifications, that will still be
    implemented during the first semester of 2007; 2) the standardizing of voluntary counseling and
    testing at AYFS; 3) the ministerial policy on incentives to school-based community activities and the
    inclusion of RSHAY contents in the secondary school curriculum, despite the reduced participation of
    PGB due to its institutional capacity. It is worth mentioning the elaboration of a new strategy to reach
    out-of-school adolescents and youth, aiming at improving the unsatisfactory achievement of the 2005
    planned targets.
    In the area of service provision, there has been an increase in the number of schools (from 233 to 325);
    youth associations (from 135 to 272); and AYFS (from 80 to 149). It is important to mention that
    70,000 HIV tests were done among young people all over the country. This represents an increase of
    almost 100% when compared to the previous year, reversing the decrease trend. Additionally, increase
    in the offer, and diversification of behavior change communication actions have provided a greater
    reach of young people, especially through national contests.
    In reference to the strengthening of government and civil society response capacity, a great number of
    plan of actions were implemented, with few exceptions like APROGE, due to operational constraints
    and time availability of related partners.
    During the year PGB had a remarkable international exposure, receiving 13 study groups from
    countries of three different continents.
    The multisectorial program co-ordination has established itself as an important managerial tool.
    Nevertheless, efforts are still needed during 2007 for its consolidation, especially in the framework of
    the recent nominations at Provincial Directions. The total budget planned for 2006 was USD
    5,064,330.69.
    The following programmatic lines are prioritized for 2007:
       Establishment of guidelines and revision of clinic-based program benchmarks;
       Establishment of partnerships with income-generation organizations;
       Improvement in the access to contraception, condoms and other key commodities;
       Use of audiovisual strategy for the production of BCC materials;
       Definition of approaches for decentralization of resources as a means to implement local actions;
       Improved follow-up for the achievement of specific targets at district and provincial execution;
       Revision of the program technical assistance, with phasing out in some provinces;
       Program expansion to Nampula Province;

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         Strengthening in the quality of program service delivery;
       Increased investment in the response capacity of the civil society at the community-based
    program;
      Implementation of studies and researches, principally in relation to the production of local
    knowledge on RSHAY and HIV/AIDS;
         Extension and expansion of regular program activities.
    A budget of USD 4,990,700.00 is proposed for the respective workplan.


    2. PGB BACKGROUND
    The adolescent and youth RSH/HIV/AIDS program started in 1999 as a pilot-project in the city of
    Maputo and in the Zambezia Province, and is implemented through a multisectorial approach by the
    Ministries of Youth and Sports, Health, Education and Culture, as well as by NGOs and youth
    associations. Program activities are in tandem with governments priorities as expressed in main
    national documents (e.g., PARPA, MDG, PEN SIDA and others), that aim at reducing the
    vulnerability of adolescents and youth to sexual and reproductive health issues, including HIV/AIDS
    through the promotion in the access to information, adoption of safe skills, and the provision of quality
    clinical services, in a perspective of human rights and gender equity.
    The high rates of HIV infection and the consequent impact in the economic productivity due to the
    loss in the work force brings an important menace in the achievements of the Millennium
    Development Goals.
    The Geração BIZ Program is implemented in nine of the eleven provinces of the country and is
    expected to achieve complete country coverage by 2008 with its expansion to Nampula and Manica
    Provinces. Among those key program strategies is the support to the strengthening of institutional
    capacity, elaboration of RSHAY policies, the reinforcement of multisectorial co-ordination, the active
    participation of young people, and the establishment of partnerships.


    3. REPORT FRAMEWORK
    The 2005 original Geração BIZ Program proposal included a set of 4 results to be achieved through
    defined targets and respective strategic actions for their operationalitazion. In the following section a
    summary of the established targets is presented, with discussion on the achievements of the workplan
    agreed during the June 2006 Tripartite Review Meeting.
    The products achieved are partially discussed through the analysis of each established result, with
    mention to monitoring and evaluation tools, geo-spatial analysis and main constraints and challenges.


    RESULT 1. POLICIES AND STRATEGIES
    To elaborate policies and strategies that promote access of adolescents and youth to information,
    development of skills, and quality reproductive and sexual health and HIV/AIDS services, in a
    perspective of human rights and reinforcement of youth participation.
    The PGB Program has given priority focus to the issue of public policies, given the understanding that
    they are essential tools for the guaranteeing of access of adolescent and youth to information and
    clinical services, as well as to enable the implementation of the adopted program strategy.

    1.1       Set of targets related to the development of multisectorial policies and strategies.
           Target 1.3. Definition of a package of incentives to peer educators at the educational sector until
            the end of 2006 (e.g., waving of registration fees, free educational materials etc.), with emphasis
            in the education of girls, thus contributing to NPAA General Objective #2 and Specific
            Objective #2.

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     Target 1.4. Consensus reaching and planning for the solution of issues related to the transfer of
      student pregnant girls and their partners for other school periods until the end of 2006, thus
      contributing for NPAA General Objective #2 and Specific Objective #5.
     Target 1.10. Support to the three Ministries in the elaboration of themes related to HIV/AIDS,
      SRH, and Sexual and Reproductive Rights in a perspective of human rights, as well as their
      inclusion in secondary school curriculum until 2007, thus contributing to PEN II General
      Objective #3 and Specific Objective #1.
     Target 1.5. Revision and upgrading of the Ministry of Youth and Sports HIV/AIDS Strategic
      Plan until 2006.
     Target 1.2. Elaboration of the protocol and algorithm for a wider introduction of HIV testing at
      the operational AYFS in the country until 2006.
     Target 1.6. Support to MISAU in the elaboration of specific PAC guidelines, including aspects
      on adolescent counseling and contraception to be implemented at all AYFS in the country until
      2006.
     Target 1.11. Support to the elaboration and production of AYFS guidelines, as well as SRH
      quality criteria to be implemented at all AYFS in the country, as well as support to the printing of
      these materials when necessary during the implementation of the program.


A package of incentives in the educational sector was elaborated for peer educators, basically related
to the guaranteeing of school vacancies and waving of registration fees to PGB peer educators. It is
important to notice the coherent and sustainable approach of these policies proposed by the technical
team of MEC, since they guarantee that students continue their studies and outreach prevention work,
thus contributing for their social development and for the country productive sector. These policies are
still awaiting the official signature of the Ministry of Education and Culture Cabinet.
There has been no advance in relation to the permanence of pregnant girls in schools, nor in the
revision of the ministerial decree regulating the issue. Since 2004 different youth associations have
chosen this fundamental topic for the focus of their advocacy interventions, but there has been no
internal consensus at MEC. It is believed that this is a key factor contributing to the lower access of
girls to schools. It is estimated that around 603/100,000 1 school girls get pregnant every year and most
of them drop out of school or are transferred to the night period. There is still need to plan field
activities to assess the impact the official decree has upon pregnant girls, with the involvement of the
Gender Unit at DPEC.
Efforts for the inclusion of RSH issues and HIV/AIDS prevention into the secondary level curriculum
continue to be done, with little need for MEC assistance to the technical team at INDE. This
demonstrates that years of technical assistance have resulted in institutional capacity at INDE.
The Strategy for Integral Youth Development (Resolution 04/96 of 20th March 2006) was approved by
MJD. This is a certification of the policies directed to out-of-school adolescents and youth.
In the clinic-based area of the program, the Trainer and Provider Manuals were elaborated, aiming at
the integration of voluntary counseling and testing services within AYFS, with the subsequent training
of 26 trainers and 90 providers in the country. Up to now activities have been initiated in
approximately 30 of the 40 AYFS planned for 2006, including the purchase of needed equipment and
materials for the implementation of VTC services. Gathering the respective coverage data for these
actions will only be possible during 2007. In this respect, the target of establishing service guidelines
and algorithm for VCT services at AYFS has been achieved.
During 2006, it was not possible to develop service guidelines for PAC services, given the need for a
more in-depth discussion of such a sensitive issue. Data from the 90’s show that unsafe abortion
complications were the second cause of death among adolescents and youth at the Central Hospital in
Maputo. Despite recent advances towards a possible change in abortion laws in the country, access to
PAC services is currently better organized at provincial hospitals and some basic health units. A great
number of post-abortion cases were managed by professionals trained in emergency obstetric skills.

1
 Source: DPEC Reports. Data from the schools (mostly secondary level) where PGB is implemented in seven
provinces of the country.
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Nevertheless, the decrease in the number of training sessions has resulted in a reduced access to these
specialized skills. At the same time, there is need to overcome those barriers to the expansion of access
to PAC services by adolescents, a result of the inconclusive discussions on the decriminalization of
abortion. The Gaza Program experience in 2005-2006 reveals that it is possible to make advances in
the access to these services and thus reduce mortality related to unsafe abortion.

                Graph 1. PAC services at Xai-Xai Provincial Hospital by age group. Gaza, Oct/05-Oct/06
        Graphic 1. Percentage distribution of PAC cases among persons older and younger than 24 years old.
                                     Xai-Xai City, October 2005 – October 2006.
   80


   70


   60


   50

                                                                                                         < 24 y.o
   40
                                                                                                         > 25 y.o

   30


   20


   10


    0
          Oct    Nov   Dec    Jan    Feb    Mar    Apr   May     Jun    Jul   Aug    Sep    Oct



Graphic 1 above shows that after the training of providers at the Provincial Hospital and basic health
care units (when associated to community interventions), the number of adolescents accessing PAC
services has increased progressively until august 2006. These data show a greater access to public
health service by young people, since it is unlikely that a greater number of abortions have occurred
immediately after the training sessions.
The preparatory phase for the quality certification of AYFS was successfully implemented. The
program intends to implement not only a strategy for the improvement of these services, but to discuss
more effective models that take into consideration shortage of human resources. A consultant was
hired to define tools and working methods as well as to train the team that will implement the AYFS
certification across the country. All of the 180 existing AYFS in the country (including those 149
encompassed by PGB) are targets for the certification process.
Despite the existence of a RSHAY policy since 2004 and presently incorporated at the National
Reproductive Health Policy, there are still many challenges facing the implementation of youth and
adolescent services. By prioritizing the in-school population, mostly through vaccination campaigns
and environmental education, the Ministry of Health does not pay the necessary attention to the out-of-
school young population. The in-school population represents less than 30% of the young people in
the country, mostly encompassing children younger than 10 years old (52% of the in-school
population), a much less vulnerable group.
The target related to the development of strategies focusing vulnerable orphan adolescents was not
undertaken during 2006, for it was considered convenient to postpone this initiative for 2007.
Regarding technical sustainability, one can say that achievements have been obtained in all of the
three sectors. At the Health sector, with the design of the Reproductive and Sexual Health Policy, that
is already being discussed but not yet approved; at the Education sector, with the strengthening and
progressive institutionalization of programs; and at the Youth sector, with the development of a new
strategy to reach those most vulnerable young people through a bigger involvement of youth centers
and associations in the response to HIV/AIDS and reproductive sexual health issues.
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1.2       Set of targets related to financial sustainability and decentralization of funds.
       Target 1.7. Decentralization of at least 40% of available resources at the Provincial Directions of
        Education and Health, and 30% at the Provincial Directions of Youth and Sports, related to
        UNFPA support, for implementation at district level through sub-agreements (until 2006 in the
        provinces of Zambezia, Maputo and Gaza and until 2008 in Cabo Delgado, Tete and
        Inhambane), thus contributing to PNCS General Objective #2 and Specific Objective #2.
       Target 1.8. Gradual inclusion within the MEC budget of those financial resources needed for
        the execution of Geração BIZ Program (20% in 2006, 40% in 2007 e 70% in 2008), and
        guaranteeing of 100% of funds allocated annually, thus contributing to PNCS General Objective
        #2 and Specific Objective #2.
       Target 1.12. Initiate during 2005 the inclusion of activities and resources related to sexual and
        reproductive health needs of adolescents and youth within the Integrated Planning (National and
        Provincial Integrated Plans) and common funds (PROSAUDE and Common Provincial Fund).


The Education and Culture Sector, and the Youth and Sports Sector have put more emphasis on the
coverage of actions on issues related to HIV/AIDS. Despite PGB activities being incorporated into
sectorial plans, it has not been possible to allocate financial resources to program activities.
Financial resources of MEC/FASE are being used in a rotational approach among different programs,
with PGB being chosen to benefit from them during 2007.
MJD and respective Provincial Directions do not count with significant resources from the overall
state budget, nor from other financial sources taking place in other sectors (common funds). In spite of
that, MJD was the sector presenting the best proposal for the Fund in Support to Youth Initiatives
(FAIJ), although stressing the focus on those resources related to income generation than on those
related to HIV/AIDS.
In addition to bilateral funds, it appears that there has been important progress in the decentralization
of resources, both from central to provincial and from provincial to district level. The DPEC at Gaza
has gained experience in the decentralization of resources to the district level through the
establishment of memoranda of understanding. This experience still needs to be evaluated and its
expansion tested in other provinces. MJD has established various fund transfers at provincial level for
the implementation of PGB activities, surpassing the planned decentralization targets.
The remaining challenge is the creation of financial transfer mechanisms among sectorial plans
focusing adolescent and youth activities so that equity can be guaranteed for this highly vulnerable
population group to the HIV/AIDS epidemic in the country.
Policies and Strategies - Constraints and Lessons Learned
     Need of robust ownership during implementation at local level.
     Significant progress in the inclusion of program activities within the plans of the Ministries of
      Education and Culture, Youth and Sports, and Health.
     Need to establish effective communication channels to influence political decisions for adolescent
      and youth support.
     The approval process of public policies depends on variety of actors, causing a significant time
      gap between planning and execution.
     Decentralization is related to simplification of management processes, but it also depends on the
      building of competences at different levels.
Policies and Strategies - Main Challenges
     A stronger approach with CNCS could improve access to technical and financial support, given
      the shortage of direct governmental funds from other sources.
     Approval of sexual and reproductive health policies, including those related to adolescents.


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     Establishment of a process for the decentralization of funds to local civil society organizations.
     Approval of incentive policies within MJD for all peer educators, an issue already being discussed
      at the Ministry.
     Establishment of standard technical norms related to AYFS.
     Certification of quality school-based programs.


                         Table 1. Achievement of 2006 Policy and Strategy Targets.




RESULT 2. NATIONAL RESPONSE IN SERVICE DELIVERY
A strengthened national response in the planning and management of RSHAY/HIV/AIDS
programs, in the implementation of RSHAY/HIV/AIDS prevention and care services to adolescents
and youth, and in the reduction of the negative social impact of HIVAIDS for this group.

2.1       Set of targets related to the expansion of PGB geographical coverage.
       Target 2.8. Expansion of PGB to all provinces in the country; Niassa during 2005, Sofala during
        2006, Manica and Nampula until 2008.
       Target 2.9. Government replacing UNFPA in Zambezia Province and Maputo City until 2008.
       Target 2.10. Expansion of PGB in 100% until 2008 in provincial districts of Inhambane, Gaza,
        Maputo, Zambezia and Cabo Delgado provinces, that do not have support from any donors, in
        at least 60% of provincial districts in Cabo Delgado, Tete and Niassa.


In relation to the expansion of PGB, it is possible to affirm that planned targets related to provinces
were completely achieved. Sofala was reached in 2006. The annual and quarterly plans were
developed in 9 provinces in the country, including those related to the three central sectors.
Regarding district converge, there has been mixed results. Out of the seventy-five districts initially
planned for 2006 in the country, PGB has reached 64. This was due to the strategy opted by the
                                                                                                           9
program for a bigger expansion in the coverage of those districts already reached. Thus, one can say
that there have been advances in district coverage with a wider reach of administrative sites other than
the district capital, with more than 86 sites reached especially by the school-based program. This has
allowed a wider spread of PGB in reaching youth with more difficulties in accessing prevention and
information.
Nevertheless, wider district coverage is expected during the following month at the new provinces.
Currently PGB is present in 100% of the Gaza, Maputo City and Maputo Province districts, in 65% of
those in Cabo Delgado, in 53% of those in Zambezia and in 62% of those in Tete.

              Figure 1. Districts reached by the program and number of residing adolescents and youth.




In the geo-spatial coverage analysis, as shown on Figure 2, colored areas reflect covered districts.
There is significant presence in the Central region, in the province of Cabo Delgado and in the
Southern area of the country. Nevertheless, there are still important areas not yet covered in the region
of Manica (despite PGB not being implemented in this province), Sofala (initiated at the end of 2006)
and Inhambane, which shows the need for a strengthening of actions in the Beira corridor and in part
of the Maputo corridor.
The phasing out process has already been initiated, with the revision of the terms of reference for
technical assistance, and the re-definition of roles and competencies within the new UNFPA Country
Program. The reduction of provincial technical consultants in 6 out of the 9 provinces aims at
increasing managerial capacity and government ownership after more than five years of institutional
capacity building for these organizations.

2.2       Set of targets related to the expansion in the access to RSH services, materials
          and education, and STI/HIV/AIDS prevention in the clinic-, community-, and
          school-based programs.
       Target 2.11. Expansion in the number of AYFS from 60 to 180 units with UNFPA support until
        2008, in the selected districts for the implementation of the 3 program components, with a total
        service capacity of 200,000 persons per year, focusing in those more peripheral health units thus
        contributing to PNCS General Objective #1 and Specific Objective #6;
       Target 2.12. To do at least 10,000 HIV tests in 2005, 20,000 in 2006, 40,000 in 2007 and 80,000
        in 2008 at the AYFS, as well as STI treatment, thus contributing to PNCS General Objective #1
        and Specific Objective #3 and #5;
       Target 2.14. To increase the use of contraceptive methods and STI/HIV/AIDS prevention
        materials in at least 50% of the initial provincial base lines, totaling 1 million young people
        covered by the program until 2008, thus contributing for PNCS General Objective #1 and
        Specific Objective #1 and #2;

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     Target 2.15. To increase free condom availability by 300% until 2008, increasing the currently
      number of 1,2 million to 2 millions in 2005, 2,5 millions in 2006, 3 millions in 2007 and 3,6
      millions in 2008, thus contributing to PNCS General Objective #1 and Specific Objective #4.


In the clinical component, AYFS numbers have increased from 80 in 2005 to 149 in the end of 2006,
greatly surpassing the target of ten new AYFS (see Graphic 4). Service provision has increased from
120,000 young people served in 2005 to 179,695 in 2006, an increase of almost 50%. Yet, there are
still difficulties in several districts, where a great number of AYFS open a few hours per day, and
many of them do not open every day because of the shortage of professionals. It is possible to assume
that if a larger investment had been done in this area we could have reached a greater number of young
people with reproductive and sexual health and STD/AIDS prevention actions. Tete Province has done
very little in reaching young people, serving only 9,196 young people at the in 14 provincial AYFS. In
Inhambane, for example, 9 AYFS alone were able to reach almost 14,000 young people during the
same period. The best coverage of AYFS in those districts where PGB has been implemented were
seen in urban districts such as Lichinga, Namaacha, Maxixe, Xai-Xai, with a coverage higher than
10% of the estimated adolescent population. However, the annual coverage of the estimated
population of young people is less that 3% in 42 of the 64 districts. As it is estimated that 34% of the
young people population is sexually active and therefore have needs in terms of RSH services, any
coverage below 13% should be cause of concern.
There has been a small reduction in the number of condoms distributed at AYFS during 2006 (less
than 1 million compared to 1,1 million distributed during the previous year). The increase in the
number of clients has not been followed by an increase in the number of condoms distributed,
probably due to shortage in stocks, lack of condom promotion during consultations, or even a larger
access to condoms distributed at schools and community.


                        Gráfico 2. Reach and condoms distributed at AYFS. nos
                        Graphic 2. Atendimentos e Preservativos distribuídos PGB,
                                         SAAJ. 2001-2006
                                               PGB, 2001-2006

            1,200,000                                    200,000

            1,000,000
                                                         150,000        Condom distributed at
              800,000                                                   YFS

              600,000                                    100,000
                                                                        Total Number of Young
              400,000                                                   people reached through
                                                         50,000         YFS
              200,000

                    0                                    0
                         2001 2002 2003 2004 2005 2006


The number of HIV tests undertaken by adolescents and youth at VCT services in the country reached
77,488. This number is very significant, showing that 2,9% of all young people undertook HIV tests in
2006. Nevertheless, there is need to increase HIV test demand by young people given the estimated
HIV prevalence of 16%. Despite VCT services being initiated only at the end of 2006, a total of 3,142
tests were undertaken at AYFS (around 5% of the country total and 1.7% of those young people
seeking services).
In reference to accessibility to condoms, of the planned target of 2,000.000 condoms to be distributed
in 2006, 1,864,000 (90%) were distributed. There remains the challenge of increasing condom
distribution during the next years, given the average of 3,4 condoms distributed to sexually active
youth per year. According to the international estimative of 8 condoms/month/young person, it would
be necessary approximately 52 millions condoms to serve the youth attending PGB alone. It is worth
to mention that PGB adolescents and youth utilize 10% of all condoms freely distributed in the
country.

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A country-wide geo-spatial analysis was conducted to assess the status and coverage of PGB and the
micro-regional differences that could facilitate improvement in technical approaches. We will present
here a summary of the most important elements found in this assessment.
Figure 2 shows a significant coverage (50%) in the Southern region of the country and in the provinces
of Maputo, Zambezia and Tete.
There is good coverage in Cabo Delgado province, but with a smaller progression than in the other
provinces. The relatively low coverage in the provinces of Inhambane and Gaza is due to the
constraints of the educational sector in expanding its actions. It is important to note that in those
districts where coverage higher than 100% was achieved this was due to the overlap of the health
sector in reaching both young people of community and school-based programs.

                  Figure 2. Percentage of youth reached by PGB per district of residence, 2006




It was observed that there are similar rates of in- and out-of-school youth attending AYFS services.
Taking into consideration that the main users of AYFS are adolescents and youth older than 15 years
old and that the proportion of out-of-school is bigger than in-school youth in the general population,
one may infer that the in-school group has more access to health services. A higher participation of
out-of-school youth was noted in some districts of Tete, Gaza and Maputo Provinces, which confirms
the efficacy of community-base programs in these Provinces. At the time of the assessment there were
no disaggregated data for the Zambezia Province.

                          Figure 3. Percentage of in-school youth seen at AYFS, 2006




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The issue of effectiveness must be discussed more thoroughly. Access to contraceptives by sexually
active girls could be strengthened further, despite recent achievements. In great part of those districts
covered by the program, rate of contraceptive use by adolescent girls at AYFS is less than 0.5
contraceptive/year. It is worth mentioning that at the AYFS of the districts of Magude, Moamba,
Namaacha and Marraquene (Province of Maputo), Vilankulos and Maxixe (Province of Inhambane),
and Cahora Bassa (Province of Tete), there were more than one visit/client to receive oral
contraceptives (see Figure 4 below).

              Figure 4. Average of contraceptives received by girls and by district at AYFS in 2006.




              Figure 5. Average of condoms distributed per youth and per district by PGB in 2006.




There has been a significant improvement in reaching out-of-school youth following the new coverage
strategy and the decision of expanding partnerships with civil society organizations. While in 2005 a
total of 305,000 out-of-school youth were reached, this number increased to 450,000 in 2006, an
increment of around 50%. The number of associations increased from 135 to 272 in one year (101%),
and the number of peer educators increased from 1,756 in 2005 to 2,496 in 2006. The increase in peer
educators and partner associations demonstrates that the decision of expanding partnerships has

                                                                                                       13
contributed for a wider reach, especially when it is observed no significant increase in the number of
districts. There has been significant reach of youth in the cities of Xai-Xai, Moamba, Namaacha,
Matutuíne, Maxixe, Cahora Bassa, Maganja da Costa, Moatize, Marracuene and Alto Molócue, where
rates higher than 50% were achieved among out-of-school youth during 2006. This illustrates that
PGB may be more effective in its community interventions at the provinces of Maputo, Gaza, Tete and
Zambezia.
As it can be seen in the Graphic 3 below, the decrease in the trend of reaching youth observed in 2005
has been reversed due to the significant increase in the number of youth associations. The number of
peer educators has remained below the planned target for 2006 (79,7%) but this has not affected the
capacity in reaching youth (49.7% above the planned target). An average of 6.2 youth were reached
every day, more importantly in those less urban districts (Morrumbene: 33.5; Tsangano: 16.3; Maxixe:
12.3; Chokwe: 11.3; Chibuto: 11.2 and Mutarara: 10.4).


                 Gráfico 3. Distribuição of youth reached, número de
               Graphic 3. Distribution de jovens atingidos, youth associations and
                          community peer educators. PGB 2003-2006.
             associações juvenis e educadores de pares na base comunitária.
                                        PGB, 2003-2006


            2500                                                   500.000
                                                                   450.000
            2000                                                   400.000       Number of Youth
                                                                   350.000       Association
            1500                                                   300.000
                                                                   250.000       Community Active peer
            1000                                                   200.000       educators
                                                                   150.000
             500                                                   100.000       Total Number of Young
                                                                   50.000        people reached through
                0                                                  0             community
                      2003       2004        2005        2006




However, 3 out of 7 districts in the City of Maputo (densely populated and with a high HIV
prevalence), almost all districts of Cabo Delgado, and the districts of Mandina and Marupa in Niassa
show coverage rates of less than 11% of the estimated out-of-school population. The civil society
associations in Maputo have improved their performance, with the definition areas for outreach work
areas and training of new peer educators. Until last year, AVIMAS only worked with out-of-school
youth, Mavalane Unit with in-school youth and AMODEFA with the two groups. Thus the out-of-
synch performance of PGB has been corrected by the end of 2006.
A total of 7.500 girls participated at the National Soccer Tournament “BIZ Girl” for the selection of
teams to participate in the final games in Maputo. Six teams made up to the finals, which were seen by
more than 4.000 people at the Maxaquene Stadium during the activities related to the International
Aids Day. Media coverage of this sport event included spots and a 10 minutes video with the
tournament’s highlights.
At the school-based program, the number of schools reached by PGB increased from 233 in 2005 to
325 in 2006, a significant increase of 40%. Similar trends were also observed in the number of peer
educators (from 2.362 to 2.577) and teachers (from 861 to 1.086). The established target of 558.000
youth reached by the school program was basically achieved (4.000 short) despite the non
achievement of those targets related to peer educators. This shows a higher productivity of school-
based peer educators, who reached in average 2 persons a day. The most consistent performance was
observed among school-based peer educators in the cities of Maputo and Cabo Delgado, who reached
between 2.2 and 7.4 youth per day (e.g., Pemba: 7.4; Macimboa da Praia: 5.0; Chiure: 4.6 youth/day).
The school-based Counseling Corners appear to be well distributed (see Figure 6), with practically one


                                                                                                          14
    Corner per district. Improvements are still needed in Inhambane, Maputo, Tete, and some districts of
    Zambezia.

                                 Figure 6. School-based Counseling Corners, 2006.




    The contest “Prevenção Também Se Canta”(One Can Also Sing Prevention) attracted around 7,000
    competitors from all provinces of the country. Eleven couples (one girl and one boy) were selected to
    participate in a 6-day workshop in Maputo, where they refined their compositions and learned about
    musical concepts. By the end of the week, the 11 pairs appeared publicly at the Francisco Mayanga
    School to an audience of around 2,000 people. A CD with the selected compositions was produced and
    will be distributed during 2007 to radios, AYFS, schools and youth associations. A 10 minutes special
    video clip of the event was also produced and transmitted by public television.

r

                            Graphic 4. Number jovens atingidos, schools and school-
                          Gráfico 4. Número de of youth reached, número de escolas e
                                      based pares na base escolar. PGB, 2002-2006
                             educadores de peer educators. PGB, 2002-2006

                3,000                                                600,000

                2,500                                                500,000
                                                                                    Number of Schools
                2,000                                                400,000

                1,500                                                300,000
                                                                                    School Active peer
                1,000                                                200,000        educators

                  500                                                100,000
                                                                                    Total Number of Young
                    0                                                0              people reached through
                                                                                    schools
                         2002    2003     2004     2005     2006




    The package of school-, clinic- and community-based activities focusing adolescents and youth
    included:
       Information and education: discussions, video sessions, interactive expositions, cultural and
        sportive events, competitions;

                                                                                                             15
     Face to face counseling interventions;
     Interactive theater sessions;
     Referrals to health services;
     Distribution of IEC/BCC materials and condoms;
     Activities at the Counseling Corners;
     Radio broadcast activities;
     Participation in study tours, seminars, conferences and others;
     Pre-natal services, STI management, contraception, counseling and HIV testing, and others.

2.3       Set of targets related to the improvement of PGB response to RSH/HIV/AIDS
          issues and related subjects.
       Target 2.6. Development in partnership with MISAU, Pathfinder and The World Bank of a pilot
        project to provide clinical care to 280 adolescent and youth with HIV/AIDS receiving ARV
        treatment, 630 families in home-based care in two sites (HCM and Xai-Xai), until 2007, thus
        contributing to PNCS General Objective #1 and Specific Objectives #4 and #8, General
        Objective # 3 and Specific Objectives # 3 #4 and to PEN AIDS.
       Target 2.7. Conduct operational research and studies that can subsidize program aspects at the
        end of Program Support, thus contributing to PNCS General Objective #6, Specific Objective
        #1.
       Target 2.18.1. Development, until 2006, of a strategy, as well as the implementation in at least
        10% of AYFS, for the provision of health and psycho-social services to youth victims of sexual
        violence..


With funds from the World Bank and the Ministry of Health, Pathfinder International and UNFPA
created a Project to youth living with HIV/AIDS in two AYFS: HCM (Central Hospital of Maputo)
and Xai-Xai. This project established within PGB can contribute for a better understanding of the
prevention/assistance continuum that is needed for a more holistic response. This will be done by
involving 10 youth organizations in the design of community proposals focusing the promotion of
HIV tests, home visits to infected patients, and reduction of stigma and prejudice interventions.
Additionally, 2 self-support groups with almost 150 youth HIV positive were established (one in each
site), bringing issues for an improvement in the public health sector, especially in counseling and
testing services, in monitoring young people under treatment, and in the need of social mobilization to
reduce stigma. Also, groups of parents/relatives were also established. From this experience it was
possible to conceive a strategy for the increase of access to HIV test called “Tempo de Saber” (Time
to Know), to be initiated in both cities in March 2007. Approximately 2,000 HIV tests were done at
the AYFS of HCM and Xai-Xai. Out of the total of 888 HIV positive clients being followed in these
services, 132 are young people receiving ARV treatment, 163 are pregnant girls under PTV, and 162
families are attended by home visits.
Related to gender and HIV/AIDS, UNFPA and Pathfinder International supported in 2006 the
establishment of a Resource Center in Tete, focusing gender and sexual violence issues. The Project
will provide a package of clinical services (AYFS), social services (income generation), legal
assistance (female police unit to advise and treating cases of sexual violence and other gender-based
violence) and HIV prevention. Through this initiative, PGB has addressed the special care needs of
vulnerable pregnant girls and women. During 2006 no operational research was implemented;
however, a more comprehensive research was done on the ways youth living with HIV deal with their
serological status.

2.4       Set of targets related to communication efforts at PGB.
       Target 2.16. Creation of a weekly radio program on RSH and HIV/AIDS issues, in partnership
        with ICS and community radios, so that at the end of the Support Program it can be broadcast

                                                                                                      16
        to the whole country and can be listened to in each Counseling Corner, AYFS and youth
        associations in the country.
       Target 2.17. Development of communication material focusing women reproductive health
        rights (especially about the right of having children or not, and intergenerational sex), thus
        contributing to PNCS General Objective #1 and Specific Objective #7.


In 2006, a new communication strategy was created through a new program called “Mama BIZ”
(Mother BIZ). This program focuses the dialog between tradition and the need for change due to the
new RSH issues and HIV prevention. It consists of a series of 15 radio programs with approximately
10 minutes each. It was launched on December 2006. Four of these programs were transmitted to the
whole country through the Radio Cidade and Radio Moçambique, on Saturday afternoons. The Radio
Program Mama BIZ, a joint effort by different agencies involved in youth communication (Nweti,
FDC and BIZ Generation), was included as an approach for communication to adolescents and youth
at the CNCS proposal.
In 2006, new Trainer and Peer Educators Manual were developed focusing intergenerational sex and
gender-based violence, besides introducing issues related to alcohol, drug abuse, and youth living with
HIV/AIDS. A training for 40 trainers, performed during the second semester in 2006, provided a
opportunity for updating knowledge and integrating these themes in the trainings curriculum to be
used during 2007.
Two educational videos were planned for, and produced in 2007, one aiming at discussing
intergenerational sex and the other serving as a pedagogical tool on interactive theater training.

2.5       Set of targets related to PGB quality improvement of PGB.
       Target 2.19. Achievement of gold-standard in at least 30% of program intervention sites in 2005,
        40% in 2006, 60% in 2007, 70% in 2008, and 80% in 2009.
       Target 3.3. Guarantee at least 5 qualified trainers in each province of the country until 2006.


The certification process of the school-based program (gold-standard) was transferred to 2007. The
certification of AYFS is already in process, as mentioned above.
A total of 101 PGB trainers participated at a certification training. Forty of them were fully certificated
and will be used as trainers for the next trainings. The target was reached in almost all provinces but
Gaza, where only 1 trainer was certificated. An upgrading process will need to be in place to secure
that local human resources are available for the training of providers and peer educators in Gaza and
Niassa.
Services Delivery - Constraints and Lessons Learned

     Logistic related to condom distribution is still a barrier;
     Coverage of HIV tests was not possible to be reached;
     Shortage of youth-specific educational material during the year;
     Shortage of health providers at AYFS is still a constraint;
     Tete Province has reversed the negative situation of 2004 and 2005, achieving a good performance
      level in the current year;
     The implementation process at school and community are not synchronic, which may result in the
      fragmentation of the intervention;
     The school-based program seems to be more homogeneous in Cabo Delgado, Tete and Maputo
      City;




                                                                                                        17
     The school-based program in Zambezia needs to advance in the coverage of districts reached by
      clinic and community actions (Lugela, Namarroi and Morrumbene). Likewise, in Inhambane
      (Vilankulos, Massinga and Zavala);
     The community-based program seems to be a bit more homogeneous in Tete, Zambezia, Maputo
      Province and Maputo City. It needs to advance in Cabo Delgado and Niassa.


Services Delivery - Main Challenges
     To support specific logistic of condoms in collaboration with CNCS and MISAU. Evaluate the
      possibility of creating a specific brand for young people;
     Increase access to contraceptives and STI treatment at AYFS;
     Increase professional health training to improve access to services;
     Post service providers at AYFS;
     Expand access to HIV testing;
     Train other providers in RSHAY;
     Perform events with national impact;
     Bigger involvement of teachers in prevention issues.


                        Table 2. Target achievements table in Servie Delivery, 2006.
                                                    Year                     Target      Result
                Table of Indicators                         Baseline                                 Status
                                                   Baseline                   2006        2006
                     Services
Number of Schools                                       2003        131           260         325      125.0%
Number Youth corners in school                          2003         23            54          83      153.7%
Number of Youth Association                             2004        138           135         272      197.1%
Number of youth centers in community                    2003         16            39          41      105.1%
Number of YFS                                           2003         14            80         149      186.3%
                 Coverage
Number of districts with program implemented
                                                        2003         21             75          64      85.3%
Number of Provinces covered by PGB                      2003          6              9           9     100.0%
Total Young People Reached                              2003     72,111      1,200,000   1,145,016      95.4%
Total Number of Young people reached
through schools                                         2003     24,512       558,214     554,344       99.3%
Total Number of Young people reached
through community                                       2003     22,433       346,661     438,889      126.6%
Total Number of Young people reached
through YFS (health providers plus activists)           2003     25,166        120,000     179,695     149.7%
Number of condoms distributed                           2003    128,475      2,000,000   1,864,892      93.2%
Number of peer educators parents involved               2005                    1,239       2,040      164.6%
Number of BCC materails distributed                     2003      9,943       250,000     117,117       46.8%
Number of HIV tests                                     2004      5,923         7,000        3142       44.9%




RESULT 3. INSTITUTIONAL CAPACITY
To have contributed to the design and development of essential tools for PGB management and
service provision.

3.1      Set of targets related to the strengthening of government response.
                                                                                                          18
       Target 2.1. To support the implementation of a resolution on the establishment of basic district
        technical teams to work on HIV/AIDS issues at the Provincial Direction of Youth and Sports
        until 2006.
       Target 2.2. To support the implementation of a resolution on the establishment of basic district
        technical teams to work on HIV/AIDS issues at the Provincial Direction of Education until
        2006.
       Target 2.3. To have a 50% improvement in PGB management process indicators in areas related
        to the Ministries of Education and Youth and Sports in at least 5 of the 7 strategic areas
        indicated by APROGE until 2007.


Technical teams working at the different Provincial Directions of Youth and Sports still require
capacity building in aspects of RSH. There has been investment in masters and doctorate fellowships
for an improvement of the technical quality of government staff.
It has been decided that district Educational and Sports basic technical teams will not be established.
Other management approaches are being discussed after the recent administrative reform and it will be
possible to invest in human resources, taking into consideration the principle of resource
decentralization.
Following a request from the involved Ministries for better conditions in gathering all technical teams,
the second phase of APROGE (Management Improvement Processes) has been transferred to April
2007.
There is need of bigger investment in the area of RSH program management. Despite the efforts in the
granting of fellowships and in local technical assistance, there is still the need for the allocation of
more human resources to oversee the multidimensional aspects of the Program.
Likewise, the start in the application of OCAT for the civil society organizations is foreseen for 2007,
thus contributing for managerial capacity building and technical and financial sustainability in the long
term.

3.2       Set of targets related to the strengthening of civil society response.
       Target 2.4. To improve capacity in resource mobilization at Provincial Directions, with at least
        one project approved in the provinces of Zambezia, Gaza and Maputo, as well as in the city of
        Maputo until 2006, thus contributing to PNCS General Objective # 2 and Specific Objective #2.
       Target 2.5. To have at least 3 Youth Associations and NGOs established and with capacity to
        deal with youth issues in each province of the country where PGB is being implemented until
        2006.
       Target 3.6. To conduct Regional Meetings (2 per region per year) with in-school and out-of-
        school peer educators for the upgrading of their knowledge on RSH and field activities, as well
        as to conduct one National Meeting every two years.


During 2006, CNCS continued to provide assistance to youth associations in the search for financial
resources for the implementation of their activities. Nevertheless, volume of available resources
continues to be limited, due to the lack of institutional capacity for managing larger amounts. The
transfer of government resources to CNCS has not been able to reach an optimum level, with the
consequent hindrance of financial control and decentralization of funds and responsibilities. There is
the need for a closer articulation between CNCS and NPCS for a long term sustainable alternative.
All provinces have been supporting the establishment of Youth Associations. This process will be
expanded during 2007, given that these associations can play an important role in the reach of
vulnerable young people. This in turn can allow the Provincial Directions of Youth and Sports to shift
its current implementing role to a more coordinating role.
The National Conference of PGB Peer Educators took place in 2006, with the participation of 51
provincial delegates previously selected during the Provincial Conferences. This meeting had as its
main objective the proposal of public policies and revision of some to PGB strategies public policies,
                                                                                                      19
as perceived relevant by the peer educators. A set of 18 points were drafted and sent to the attention of
different Program levels; also, a Maputo Letter was delivered to the President of the country by the
Ministry of Youth and Sports. This can be seen as the beginning of a stronger participation of the civil
society in the lobby with police-makers at the three Ministries.
A Youth Network was established at the end of the Conference, with representatives from the
provinces involved in PGB and coordinated by a team from Zambezia. The network will begin
working in 2007, with special focus in the follow-up of UNGASS indicators, the follow-up of the 18
points defined during the Conference, and in the establishment of links with other African Youth
Networks.
Three strategic planning exercises were conducted during 2006 as a means to strengthen the response
of the civil society in the province of Maputo and in the cities of Tete and Maputo. These plans have
been incorporated by the respective Provincial Directions.
Youth have participated at the following events:
     International AIDS Conference: 6 participants from PGB;
     United Nations: participation at the HIV/AIDS UNGASS Meeting;
     United Nations: meeting of UNFPA young leaders;
     Addis Ababa: meeting of Young UN Ambassadors (one of the four ambassadors to hand the
      meeting declaration to the UN General Secretary was from PGB);
     VI Brazilian HIV Prevention Congress: with the participation of a delegation of 18 teachers from
      the Estamos Juntos Project.

3.3       Set of targets related to the improvement of monitoring and evaluation systems.
       Target 3.1. To have installed until 2005 a computerized monitoring and evaluation system at all
        national and provincial directions with links to PGB.
       Target 3.2. To have provided to all Provincial Health Directions until 2005 the knowledge on the
        monitoring and evaluation tools and the certification of quality AYFS.
       Target 3.5. To develop until 2006 an operational system to assist in the decision making process
        of Program managers, based on scientific evidence and cost/benefit until, thus contributing to
        PNCS General Objective #6 and Specific Objective #1.


The Program monitoring and evaluation system was improved during 2006. A new software was
developed to correct the problems detected in the previous version. Despite maintaining a very similar
structural basis for information management, the new system is more user-friendly and offers less
possibility of wrong data entry. Practically, the new version has been installed in all provinces.
At the same time, there has been an improvement in the whole network of computers, with a
consultant agency providing assistance in the maintenance of equipment and access to the internet. It
was possible to fix more than 12 computers and printers that were apparently broken, but in reality had
been infected by virus and were handled by inexperienced technicians. This represented not only an
economy for PGB but for the Provincial Directions as well.
Training sessions were offered to all provincial technicians in order to improve their managerial skills
in dealing with the new system installed.
It is important to mention that the process of revising the clinic-based monitoring and evaluation
system in under way. Internal processes related to the Community Health still need to be implemented,
and there are sectors still needing to be involved, including the Ministry of Health.
In reference to the means of evaluation the Program, a variety of actions are planned to take place in
2007:
     Bi-annual knowledge, attitude and practice (KAP) studies in Niassa and Inhambane;


                                                                                                      20
     Assessment of AYFS client satisfaction, to be conducted Satisfação de clientes dos AYFSs, to be
      conducted in tandem with the certification process;
     Cost/efficacy study;
     Independent mid-term review;
It is also planned for the current year the implementation of a geo-spatial study disaggregated by
district for an in-depth analysis of the PGB impact in terms of population coverage. Only those studies
of cost/efficacy and KAP will be able to provide more appropriate elements to evaluate the impact of
the actions in the behavior change of adolescents and youth reached by the Program.

3.4       Set of targets related to technical assistance.
       Target 3.8. Promotion of technical assistance to all program implementers to ensure institutional
        development.


Technical assistance continued to be provided in the same parameters previously defined, i.e., a
technical adviser for each Ministry and a technical adviser for each Provincial Direction of Education
and Culture and Youth and Sports. There was no representative from the Health sector due to the
limitations imposed by the Ministry of Health on the presence of technical advisers at Provincial level.
With the new UNFPA Country Program, there will be only one adviser for the Provinces of Maputo,
Gaza, Inhambane, Tete, Zambezia, Cabo Delgado and Maputo City during 2007. Provinces more
recently involved in the Project will have one adviser for each Provincial Direction. Three regional
advisers will be hired to provide regular technical assistance to Provincial Directions.

                      Table 3. Number of Technical Assistants and Partners of PGB, 2006

                                          Education    Youth       Health      Partners
                     City of Maputo          1           1           0           12
                     Maputo                  1           1           0            9
                     Gaza                    1           1           0            8
                     Inhambane               1           1           1           11
                     Tete                    1           1           1           15
                     Zambezia                1           1           0           11
                     Niassa                  1           1           0            2
                     Cabo Delgado            1           1           0            9
                     Sofala                  0           0           0           n/a
                     Central Level           1           1           1           17
                     Total                   9           9           3           94


There has been investment in capacity building through capacity building trainings and workshops, as
well as participation in study tours and congresses. The technical team grew consistently each year, as
well as the team of teachers and health providers.
Additionally, the “Estamos Juntos” (We’re Together) Project, a bilateral cooperation between the
Health and Education Ministries of Brazil and Mozambique, with the objective of promoting the
exchange of experience of peer educators/teachers of the Biz Generation Program and the Brazilian
Program “Health and Prevention at Schools”, principally in the areas of STI/HIV/AIDS planning and
interventions. The first project meeting took place in the City of Maputo in the period February 11-24,
2006, with the participation of 18 Brazilians (14 teachers and 4 managers) and 18 Mozambicans (14
peers educators/teachers of PGB, 2 PGB peer educators of the City of Maputo, and 2 managers from
the provincial and central level). During the meeting each participant identified a problem to be faced
and prepared a workplan to be developed at his/her own school.


                                                                                                       21
From February to October, teachers/peers educators and managers developed the activities contained
in their workplans, which were monthly monitored by the DPEC and the Ministry of Education and
Culture at central level.
The second meeting took place in the city of Belo Horizonte, Brazil, during the period November 4-
18, when it was possible to present individual experiences, to define a monitoring and evaluation plan
and to deepen their knowledge in some themes, such as bioethics, sexual rights, sexual diversity,
racism, and drug use.
The teachers that participated at the Project’s second meeting were also able to attend the “VI
Brazilian STD/HIV/Aids Prevention Congress” that gathered more than 3,000 people.
In September 2006, the “Estamos Juntos” Project conducted another meeting without the participation
of Brazilian teachers and managers. This meeting congregated 120 PGB peers educators/teachers from
several provinces. Trainings were performed through three regional events: South region, in the City
of Xai-Xai; Central Region in the Zambezia Province; and North Region in the Province of Cabo
Delgado. Each participant elaborated an action plan for their own school, which will be implemented
and monitored by their respective DPEC.



                       Gráfico 5. Número de pessoal técnico capacitado.
                      Graphic 5. Number of technical trained staff . PGB, PGB,
                                              2001-2005
                                         2001-2005


              600                                               1.250

              500
                                                                1.000      Technical Staff
                                                                           Trained
              400
                                                                750        Trainers
              300
                                                                500        Teachers
              200
                                                                           Providers trained
                                                                250
              100

                0                                               0
                      2001   2002   2003   2004   2005   2006




                    Table 4. Achievement of Institutional Capacity Targets for 2006




                                                                                                   22
                                                        Year                     Target       Result
                   Table of Indicators                          Baseline                                   Status
                                                       Baseline                   2006         2006
                  Technical Capacity
    School Active peer educators (cumulative)              2003        1,792        3,012         2,577       85.6%
    Community Active peer educators (cumulative)           2003          784        2,406         1,917       79.7%
    Trained Health Providers (cumulative)                  2003           60          449           543      120.9%
    Teachers (cumulative)                                  2003          564          900         1,086      120.7%
    Technical Staff Trained                                2003          144          100            68       68.0%
    TOT                                                    2003           16           55            40       72.7%
    Trained Health Providers in VCT                        2003           17           90            90      100.0%
              Monitoring and Evaluation
                                                                          not        study         TOR
    Cost-efectiveness study conducted                      2004                                                 late
                                                                   developed     conducted    developed
                                                                  3 provinces        study        study
    Certification of YFS conducted                         2004                                              on time
                                                                   investigate    designed     designed
                                                                          not        study           not
                                                           2004                                                 late
    Golden Standard of youth corner developed                      developed      designed     designed
                                                          2001/
    Publications                                                                                             on time
                                                           2004             1             1            1
    Operational research                                                                  1            0        0%



Institutional Capacity Building - Constraints and Lessons Learned
   Lack of advisers at the health sector has reduced the speed in the program implementation
    at the provincial level;
   The changes in the monitoring system have benefit the Program with an improvement in
    information sharing;
   At district level, the shortage of expertise caused problems in the program decentralization;
   The allocation of resources to youth associations has been a challenge since many of them are still
    not legalized;
   The investment in youth participation has brought important results in the promotion of policies
    and rights;
   The low capacity in equipment maintenance of Provincial Directions, plus the amount of time and
    resources spent by PGB for repairing and/or replacing them has created considerable budget
    constraints.
Institutional Capacity Building - Main Challenges
   Implementation of a cost-efficacy study;
   Transition for Government replacement of UNFPA in Maputo City and Gaza, Zambezia and
    Maputo Provinces;
   Establishment of Decision Making and Evidence-Based Management Systems;
   Participation in national and sectorial studies;
   Improvement of technical capacity at local and district levels.



RESULT 4. MULTI-SECTORIAL RESPONSE
To strengthen the multi-sectorial co-ordination capacity at central, provincial, district and local
level for a better use of available resources and integration of efforts, activities and services.
Multi-sectorial response - Advances in the achievement of targets
The concept of the Program emphasizes multi-sectorial co-ordination as a key element for the efficient
use of resources and synergy. The following activities were carried out with the participation of other
Geração Biz Program partners:
                                                                                                                23
   Quarterly meetings with the directors of the three sectors (central and provincial level);
         o    Planning activities together
         o    Harmonization of sectorials plans
         o    Improvement of new methods
   Coordination with NPCS (Provincial Nucleus Against Aids);
   Annual Meeting Analysis;
   M&E System: conception and implementation;
   Study tours, conferences and short-term courses.
An issue to be addressed is the difficulty in carrying out multisectorial meetings in all provinces. In
general, there is the need for increased efforts so that they can be implemented more regularly and thus
guarantee a multisectorial approach.
The Committee should act as a co-ordination/harmonization/decision making mechanism for the
overall program management. This includes the approval of quarterly programmatic reports and
financial reports, as well as plan of activities and corresponding budgets. The Committee should also
ensure that a multi-sectorial approach is present in all program stages and that the referral system is
strengthened.
The Program has provided specific assistance to the Provincial Aids Advisory Councils.
Multi-sectorial constraint
   In many provinces it was not possible to implement the four 4 annual meetings as planned.
Main multi-sectorial challenges
    Inclusion of youth representatives at all levels of multi-sectorial program management, although
this is an issue still being discussed;
   Implementation of multi-sectorial activities;
   Sensitization and strengthening of youth associations as potential partners for debate with civil
society;
   Discussion on the availability of condoms in all three sectors;
   Establishment of multi-sectorial agreements with the aim of exemption of infra-structure rates and
fess.



4. PROJECT EXPENDITURE
The table below shows PGB expenditure for the period 2001-2005. It is important to note that the
average cost for each young person reached by the program has decreased dramatically throughout
these years, especially in the period shown below.




                                                                                                     24
                                           Table 5. Income and related expenses PGB, 2006.

2006 Income & Expenditure Report for ASRH/HIV/AIDS UNFPA Maputo (Preliminary)
    Year                                                                          2006
Donors /                         Balance                                        Total                Total                      Balance
                                                    Income 2006
Fund                            1 Jan. 2006                                     Available            Expenditure                31 Dec 2006
                                      A                         B                     C=(A+B)                 D                   E=(C-D)
                                     USD                      USD                                             USD                    USD
DANIDA                             $53,085                $851,786                   $904,871               $32,779               $872,092
SWEDEN                             $268,914              $1,932,669                  $2,201,582          $1,957,114               $244,468
NORWAY                            $1,025,711             $1,444,623                  $2,470,334          $2,254,633               $215,701
UNFPA                                 $0                  935,680                    $935,680            $935,680                           $0
TOTAL                             $1,271,291             $5,164,758                  $6,436,049          $5,180,207              $1,255,843




             Graphic 6. Total annual expenditure and cost by young person
                                reached. PGB 2001-2006.
             Graph 6. Annual Expenditures and cost per young people reached. PGB, 2001-
                                                                              2006



                                6000000                                                                                    140
                                                              131.61
                                                                                                            5,054,330
                                5000000                                                                                    120
           Total Expenditures




                                                                                                                           100


                                                                                                                                    Cost per young
                                4000000                                                  3,831,643
                                                                          3,665,005                                        80
                                3000000                                                           3,320,717
                                                              2,855,466
                                                                                                                           60
                                                                          50.82
                                2000000
                                                                                                                           40

                                1000000
                                           11.49                                                                           20
                                                    216,059                             5.27
                                                                                                     3.24           4.41
                                 00000                                                                                     0
                                             2001        2002          2003          2004         2005        2006



                                                                Annual Expenditures
                                                                Cost per adolescent reached




                                                                                                                                                     25

								
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