Adolescent Reproductive Health Needs in Kenya A Communication

THE JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH CENTER FOR COMMUNICATION PROGRAMS Adolescent Reproductive Health Needs in Kenya: A Communication Response Evaluation of The Kenya Youth Initiatives Project Prepared by: Karungari Kiragu Carol Van Hulzen-Sienché Emily Obwaka Dan Odallo Edited by: Suzanne Barth Johns Hopkins University Population Communication Services March 1998 Acknowledgments The Kenya Youth Initiatives Project (KYIP) was conducted under the auspices of the National Council for Population and Development (NCPD) and a Project Advisory Committee composed of a coalition of Kenyan youth-serving organizations, including the Family Planning Association of Kenya (FPAK) and the Kenya Association for the Promotion of Adolescent Health (KAPAH). The Centre for the Study of Adolescence (CSA) conducted formative research for the project. The Kenya Broadcasting Corporation was instrumental in the production and airing of the two weekly radio programs, Youth Variety Show and Dau La Ujana. Many organizations were critical to the successful implementation of this project. Deepest appreciation must go first to the Project Advisory Committee under the exceptional leadership of the NCPD and the FPAK. The unique partnership between organizational and individual members of KAPAH ensured that the project benefited from a diverse perspective grounded in the needs of Kenyan youth. Much of the project‟s success must be attributed to the sense of purpose that KAPAH provided. The role of CSA and its contribution to the research activities gave the KYIP an important beginning. The support of the Ministry of Health and the Kenya Broadcasting Corporation ensured that the project stayed on course. There were many field operators, too many to thank all here. The teams that produced and broadcast the radio programs were indispensable to the project. The health care providers who worked with the young people must be specially recognized, as must the national and district advocates. Appreciation goes to the policy makers, leaders and members of the communities that met with the advocates. Their willingness to learn the facts about youth in Kenya, and their desire to take positive action, is an encouragement to all who advocate for young people. Most of all, gratitude is extended to the many adolescents who responded to this project with youthful enthusiasm, thoughtful questions, and high expectations. Technical assistance for the project was provided by Johns Hopkins University/Population Communication Services (JHU/PCS) staff Dan Odallo, Emily Obwaka, Carol Van Hulzen, Michael Blake, Susan Krenn, Benjamin Lozare, and Karungari Kiragu. Michele Booth Cole, formerly of Advocates for Youth, and Margot Zimmerman, of the Program for Appropriate Technology in Health (PATH), provided important technical input. Funding for this project was provided by the United States Agency for International Development (USAID) under the JHU/PCS project Cooperative Agreement DPE-3052-A-00-0014-00. Additional funding was provided by Johnson and Johnson (K) and by the United Nations Population Fund (UNFPA). To these supporters, gratitude is extended. iii Kiragu, K., Sienche, C., Obwaka, E., Odallo, D. and Barth, S.: Adolescent Reproductive Health Suggested Citation: Needs in Kenya: A Communication Response - Evaluation of the Kenya Youth Initiatives Project. The Johns Hopkins School of Public Health, Center for Communication Programs, Baltimore, March 1998. This publication may be reproduced without permission provided the material is distributed free of charge and Johns Hopkins Center for Communication Programs is acknowledged. Opinions expressed in this report are those of the authors and do not necessarily reflect the views of the sponsoring agencies. iv Contents Acknowledgments.................................................................................................................................iii Figures and Tables................................................................................................................................ vi Abbreviations ....................................................................................................................................... vii Summary.............................................................................................................................................viii I. BACKGROUND .............................................................................................................................. 1 II. ADVOCACY ACTIVITIES ........................................................................................................... 4 Program Analysis and Formative Research .............................................................................. 4 Strategic Design ........................................................................................................................ 6 Implementation.......................................................................................................................... 8 Evaluation Findings ................................................................................................................ 10 Discussion ............................................................................................................................... 15 Lessons Learned ...................................................................................................................... 16 III. EDUCATION ACTIVITIES ....................................................................................................... 19 Program Analysis and Formative Research ............................................................................ 19 Strategic Design and Materials Development ........................................................................ 20 Implementation........................................................................................................................ 21 Evaluation Findings ................................................................................................................ 22 Discussion ............................................................................................................................... 32 Lessons Learned ...................................................................................................................... 33 IV. CONCLUSION ............................................................................................................................ 34 References ............................................................................................................................................ 37 Appendix I: Strategy Pack Assessment .............................................................................................. 38 Appendix II: District Resource Identification Form ........................................................................... 40 Appendix III: Advocacy Activity Report Form .................................................................................. 44 Appendix IV: Leaders Conference Assessment Form ......................................................................... 50 Appendix V: KYIP RhINO Questions ................................................................................................ 53 Appendix VI: Centre Source of Referral Form ................................................................................... 55 v Figures and Tables Figure 2.1 Figure 2.2 Figure 2.3 Table 3.1 Table 3.2 Figure 3.1 Figure 3.2 Figure 3.3 Table 3.3 Figure 3.4 Leader Response to Tetea Vijana Strategy Pack ....................................................... 11 Types of Audiences Visited by District ...................................................................... 13 Percent of Support for Issues Discussed ..................................................................... 14 Demographic Characteristics of RhINO Survey Respondents .................................. 23 Percent of Youth Variety Show Listeners Nationwide ............................................... 24 Percent of Youth Variety Show Listeners Nationwide ............................................... 24 Exposure to Dau La Ujana in Past 6 Months by Age Group .................................... 25 Behavior Change as a Result of the Youth Variety Show .......................................... 27 Cost-effectiveness of the Youth Variety Show............................................................ 28 Source of Referral to the Clinic, 1995 ....................................................................... 28 vi Abbreviations AIDS CSA DDC FGD HIV IEC FPAK FPPS JHU/PCS JHU/CCP KAPAH KYIP MOH NCCK NCPD NGO STDs UNFPA USAID YSOs acquired immune deficiency syndrome Centre for the Study of Adolescence District Development Committee focus group discussion human immunodeficiency virus information, education, and communication Family Planning Association of Kenya Family Planning Private Sector Project Johns Hopkins University/Population Communication Services Johns Hopkins University/Center for Communication Programs Kenya Association for the Promotion of Adolescent Health Kenya Youth Initiatives Project Ministry of Health National Council of Churches of Kenya National Council for Population and Development nongovernment organization sexually transmitted diseases United Nations Population Fund United States Agency for International Development youth-serving organizations vii Summary The Kenya Youth Initiatives Project (KYIP) was implemented through the collaborative efforts of 26 Kenyan youth-serving organizations to address the issue of youth reproductive health. The project had two key components: 1) an advocacy and networking component designed to reach national and district decision makers and 2) an education component designed to inform youth about reproductive health, encourage them to seek appropriate counseling and services, and foster better communication between parents and their children. The project began in 1994. Although activities were designed to terminate in 1996, supplementary funding was sought and aspects of the project are ongoing. The advocacy activities were carried out by a cadre of about 40 specially trained advocates who met with national and District Development Committee leaders to increase their knowledge of the consequences of unintended pregnancy, STDs, and HIV/AIDS and to solicit their support for appropriate sexuality education, counseling, and services for Kenyan youth. Advocates met with leaders one-on-one or in groups to explain how current reproductive health policies often adversely affect the health of the young. At the end of each session, leaders were urged to speak publicly in favor of adolescent health programs; to sponsor bills and policies that facilitate access to reproductive health information, counseling, and services; and to initiate and encourage collaborative intersectoral dialogue about how to improve adolescent reproductive health. By seeking public commitment from local leaders, advocates helped move this usually volatile debate in a constructive direction, strengthening the potential for positive action. Evaluation results estimate that nearly 10,000 leaders were reached by this national effort, including the Vice President, cabinet ministers, members of parliament, local officials, and heads of community organizations. Policy makers all over the country were highly supportive of providing adolescents with education and counseling, and there was also considerable support for adolescent reproductive health services. However, concerns about contraception for youth remain, especially within the religious establishment. Leader response to advocacy efforts was highly enthusiastic, with over 90 percent responding that they would use project materials in community meetings and that they wanted to be more involved in youth issues. In fact, the Strategy Pack became an important source of information for the leaders, and there is evidence that policy makers are quoting its data in speeches. Many leaders who were vocal against adolescent reproductive health interventions appear to have toned down their opposition. There is also evidence that advocacy efforts, by publicizing the recent reversal of the policy of expelling pregnant schoolgirls, helped ensure that the new law would be made clear to all headmasters and that the Minister would be supported in addressing such a sensitive matter. Adolescent reproductive health has now become an even greater priority at a policy level, as attested to by the recent sessional papers on AIDS as well as the national IEC and Advocacy Strategy. Members of the KYIP Project Advisory Committee participated in drafting this paper, articulating issues that had been identified during the project. Project Advisory Committee members also participated in drafting the sessional paper on HIV/AIDS, which has been tabled in parliament. The Ministry of Health plans a National Reproductive Health Policy, in part as a result of the advocacy viii efforts. These progressive steps show that once provided with information, Kenyan leaders are ready to assist in addressing the reproductive health crisis facing today‟s adolescents. The education efforts of the KYIP included two radio programs, the Youth Variety Show, which broadcast 79 episodes, and Dau La Ujana, which broadcast 26. The Youth Variety Show was an interactive, hour-long English-language program that aired on Saturday mornings. The show was hosted by well-known personalities and was designed to provide young people with information related to growing up, with a special focus on reproductive health. Each episode featured a panel of adolescents and expert guests who would discuss various issues to stimulate open dialogue. Telephone calls from young listeners were also taken on the air to encourage participation and exchange of perspectives and experiences and to answer questions. Dau La Ujana was a 15-minute radio drama in Kiswahili, broadcast Sunday evenings. The story revolved around a teenage girl and her interactions with her supportive parents and boyfriend, whose parents were not supportive. In the context of the story, the show explored many of the issues teens face, using humor and proverbs generously to convey messages about responsible sexual behavior. Evaluation results suggest that over half the youth interviewed in a nationwide survey were listening to the Youth Variety Show, translating to over 3.3 million adolescents. Roughly 41 percent of the adults interviewed were also listening to the program. Nearly a fifth of the youth had become avid listeners of the program, making time to listen to the weekly program regularly. Just about 40 percent of youth and adults were also listening to Dau La Ujana. Analysis of data from three youthserving sentinel sites showed that radio had become the leading source of referral to youth clinics. For example, at the inception of the program, only 23 percent of the youth cited radio as the main source of referral; within four months of the initiative‟s commencement, 56 percent of the youth cited radio, while all other sources of referral declined or remained unchanged. The Youth Variety Show reached the 3.3 million youth at a cost of 0.03 US$ (three cents) per adolescent reached. Nearly 1.1 million youth recommended the program to others, at a cost of 0.09 US$ per youth to encourage others. Over 800,000 took an action as a result of the show, at a cost of 0.12 US$ per youth. Among these, 60,000 visited a youth clinic or wrote or called the program producers, translating to $1.62 per youth who took such an action, about the cost of a loaf of bread. These data show that reaching young people and encouraging positive health behavior can be achieved at relatively little cost. ix I Background Kenya‟s population was estimated at 29 million in mid-1997 (PRB 1997), and almost half of the current population is under the age of 15 (NCPD 1997). These young Kenyans are very much like their parents and grandparents, but the problems of today that confront millions of adolescents are different from those of past generations. The modern world presents its own complicated set of challenges to the young, and when problems persist in such a large segment of the population, they exact a tremendous price from society. The social, economic, and cultural repercussions of uninformed behavior by youth pose a serious threat to the country‟s growth and development. Unwanted pregnancies, sexually transmitted diseases (STDs), abortions, and the related consequences of dropping out of school, ill health, unemployment, and poverty burden all of society and jeopardize its future stability. According to research, there were 142,000 unwanted pregnancies last year among girls age 15 to 19 and 252,000 abortions in the same age group, despite the fact that abortion is illegal in Kenya (CSA 1995). Almost 50% of girls who reach the age of 20 have had a pregnancy. The incidence of HIV infection is increasing, with 515,000 youth age 15 to 24 estimated to be HIV positive by the year 2000. Almost 15 percent of the country‟s GDP in the year 2000 is expected to be consumed by AIDS and AIDS-related conditions (NCPD 1997). The Kenya Youth Initiatives Project (KYIP) was initiated to inform youth about responsible sexual behavior, to encourage parent-youth dialogue, and to reform the policies that affect adolescent reproductive health. In pursuing these objectives and as part of a concerted effort by Kenyan youth advocates to reduce the rates of unwanted pregnancy and STDs, including HIV/AIDS, the KYIP commenced in April of 1994. While it was designed to end in December 1995, additional funds were sought, and some aspects of the project are still operational. The project was implemented under the guidance of a Project Advisory Committee composed of representatives from 26 Kenyan organizations. The National Council for Population and Development (NCPD) served as Chairman for the project, and the Family Planning Association of Kenya (FPAK) was the implementing agency. The Centre for the Study of Adolescence (CSA) conducted the formative research, with the Program for Appropriate Technology in Health (PATH) providing additional qualitative research. The project was funded by the United States Agency for International Development (USAID) with Johns Hopkins University/Population Communication Services (JHU/PCS) providing technical assistance. A key member of the KYIP team was the Kenya Association for the Promotion of Adolescent Health (KAPAH), whose membership consists of about 30 youth-serving organizations. Members come from both the governmental and non-governmental sectors and include educators, physicians, and researchers as well as organizations that focus on youth issues. Many KAPAH member organizations were also members of the KYIP Project Advisory Committee, and in fact, the KYIP agenda became KAPAH‟s agenda. With this broad membership base strengthening advocacy and networking activities, KAPAH was able to provide critical mass support for adolescent reproductive health issues. The collaboration among Kenyan organizations in implementing the KYIP was one of the instrumental factors in the project‟s success. Youth-serving organizations, media institutions, research organizations, and donor and cooperating agencies contributed to the project‟s The Kenya Youth Initiatives Project 1 implementation. It was the first time these entities had coordinated their efforts, and the result was a diverse, resourceful, and committed coalition. With encouragement and support from this coalition, the KYIP worked to bring the public debate on youth reproductive health issues to the foreground of national concerns. The design for the KYIP was based on findings from an Information, Education, and Communication (IEC) needs assessment conducted in 1992 by the NCPD, the FPAK, the Family Planning Private Sector Project (FPPS), USAID, and JHU/PCS (Kumah et al. 1992). The key conclusions of the assessment were as follows:      “Youth friendly” policies were needed to create a positive climate for organizations serving the youth population. Youth, parents, and policy makers all needed information about sexuality and the consequences of sexual activity among youth; youth also needed information about available services. Youth and parents needed interpersonal communication skills to facilitate discussion about sexuality. Youth, and particularly girls, needed skills to manage boy-girl relationships. Ongoing youth programs needed professional IEC support and materials. Planning efforts needed to include ways to educate youth not attending school. Consideration of the specific recommendations from the IEC needs assessment resulted in a project with two essential components: 1) advocacy and networking targeting policy makers and 2) information and education for youth and parents. The following objectives were defined for the project: Institution-building:  improve the capability of the NCPD to coordinate a comprehensive youth IEC program within the strategic framework of the national population program  establish within youth-serving organizations the capability to design, implement, and evaluate a comprehensive youth IEC program designed to achieve measurable change in youth sexual behavior Communication:  increase policy makers and community leaders‟ understanding of the consequences of unwanted pregnancies and STDs among Kenyan youth  encourage policy makers and community leaders to support and advocate for appropriate sexuality education, counseling, and services for youth  increase the knowledge of youth aged 10 to 19 about the consequences of irresponsible sexual activity; encourage healthy and responsible sexual behavior  encourage youth who are not yet sexually active to postpone the onset of sexual activity; encourage sexually active youth to seek counseling and appropriate services  foster communication between youth and their parents about sexuality issues 2 The Kenya Youth Initiatives Project Developed from a broad-based analysis of associated factors, and strengthened by the talents of a committed coalition, KYIP interventions impacted notably on the advocacy efforts of youth-serving organizations as well as on the educational needs of Kenyan youth and parents. Future projects focused on helping youth grow into responsible adulthood will benefit from the KYIP model and lessons learned. This report explains the KYIP interventions and presents an evaluation of their impact. Part II of the report describes the advocacy component of the initiative. Lessons learned are also discussed. The educational component, along with lessons learned on how to reach youth, is described in Part III. The Kenya Youth Initiatives Project 3 II Advocacy Activities The KYIP was one of the first advocacy-related projects in Kenya to address the reproductive health needs of youth. The advocacy initiatives were developed in response to the results of the 1992 IEC needs assessment. The needs assessment characterized the policy environment as “unfriendly” to youth and youth-serving organizations. In particular, the assessment identified threatening, ambiguous, and contradictory laws that constrain the development of successful programs for the young. The assessment also determined that policy makers and community leaders all needed more accurate and complete information on reproductive health issues. The KYIP advocacy initiatives were therefore directed at improving the policy environment and encouraging leaders‟ understanding of reproductive health issues.1 Analysis and Formative Research To inform advocacy activities, the KYIP contracted the CSA to conduct extensive qualitative research. Two studies were instrumental in guiding advocacy activities: “A Content Analysis of Media Reports Pertaining to Adolescent Reproductive Health Issues in Kenya” and “A Review of Youth Reproductive Health with Special Attention to Legislative and Policy Environment for Adolescents in Kenya”. The analysis of media coverage studied newspaper and magazine reporting on adolescent reproductive health issues. The themes and issues tracked by researchers included pregnancy, abortion, early marriage, family planning, contraceptives, family life education, marriage, STDs, HIV/AIDS, school drop-out, rape, incest and defilement, drugs, alcohol use and abuse, circumcision, and the effects of media coverage on youth behavior. Among the findings of the review were the following:    Issues regarding morality tend to receive more media attention, particularly if they pertain to youth; issues on youth sexual behavior tend to be provocative, thus eliciting controversy. Media coverage of public debate involving powerful personalities receives more publicity, and the views expressed are often perceived as policy. However, frequently these views are informal opinions presented in the context of political competition. More emphasis should be placed on the role of the media in highlighting issues related to adolescent reproductive health. The review of the legislative and policy environment examined Kenyan laws, sessional papers, general guidelines, public pronouncements, and the reports of national leader conferences. The following findings emerged (KYIPa 1996): The KYIP was based on the P-Process, a five-step framework to guide the development of strategic health communication. The P-Process was created in 1982 by Population Communication Services at the Johns Hopkins University Center for Communication Programs. For more information, contact the Johns Hopkins University Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD 21202, E mail: Webadmin@JHUCCP.org; Web page: http://www.JHUCCP.org. 1 4 The Kenya Youth Initiatives Project    The Kenyan government is reluctant to make reproductive health information or contraceptive counseling services available to adolescents; the provision of reproductive health services to adolescents is prohibited without parental consent. The family life education promoted in primary and secondary schools is very basic in content. There is no single legislation dealing exclusively with adolescent reproductive health. The legal context for youth is inferred from laws that specifically address either children or the general population. A third research initiative was to interview national, district, and community leaders to learn more about their perceptions of and attitudes towards youth reproductive health issues. Leaders from 12 districts were selected based on their being representative of different socio-cultural groups in Kenya (KYIPb 1996). Leaders were grouped as national, religious, local, and women leaders as well as leaders from youth-serving organizations. One hundred leaders were interviewed, with the key findings as follows:     Few leaders mentioned reproductive health as a major problem affecting young people in Kenya today. Rather, unemployment, drug abuse, and idleness were at the top of their list. Although leaders were aware of adolescent reproductive health problems, they did not associate them with negative or non-supportive policies, nor did they see a role for themselves as policy makers in minimizing or managing these problems. STDs, including HIV/AIDS, were viewed as problematic and common in nearly all districts. Although teenage pregnancy was known to be common in all districts, only one-third of leaders viewed it as problematic. Only a fifth of those interviewed indicated a knowledge of programs and organizations that specifically serve Kenyan youth. A majority acknowledged that there was no government policy to discourage the transmission of STDs or help modify irresponsible sexual behavior among the young. The interviews also revealed that many leaders privately favored providing better education and services to the young. Many leaders in fact cited a personal experience in their family of a teenage pregnancy or STD. As parents, they expressed their understanding of the perils and their desire to ameliorate the situation, offering interviewers encouragement to continue their efforts. At the same time, however, they expressed apprehension about publicly supporting programs for youth since it was such a controversial issue. In light of the findings from the needs assessment and the research data collected, the aim of KYIP‟s advocacy was to help leaders understand that their inaction was increasing the severity and magnitude of adolescent reproductive health problems and that these serious problems could be managed and finally prevented with appropriate education and programs. The challenge for the KYIP was to transform private opinions and misconceptions into public support and action. KYIP organizers realized that if public support for appropriate education and services could be demonstrated through public debate, then leaders would act to promote favorable policies. The advocacy strategy therefore concentrated on enhancing the public debate while also making The Kenya Youth Initiatives Project 5 available to leaders accurate information. It was the project‟s hope that these efforts would lead to a policy environment conducive to both informed discussion and intelligent legislation on youth reproductive health issues. Strategic Design The formative research led to the development of two key workshops. Both workshops were concerned with providing accurate information as well as encouragement to Kenyan leaders and policy makers. The first workshop, the Message Design Workshop, was held in February 1995. During this workshop, materials and key messages for leaders were developed. These materials would be used to make information available to leaders and to enhance the public debate about adolescent reproductive health programs. The following messages and calls to action for leaders were chosen:    Be a caring leader and invest in the health of youth because youth reproductive health problems, which lead to socio-economic burdens, are preventable. The consequences of youth engaging in sexual activities are life-threatening and costly. Leaders have an important role to play: it is their responsibility to speak up and support the improvement of reproductive health programs for youth. The advocacy materials developed in the workshop were collected in an attractive Strategy Pack called “Tetea Vijana” (Swahili for “Advocate for Youth”). The Strategy Pack had to be professional enough to appeal to policy makers. Although more Strategy Packs had been planned, only 3000 were prepared, due to a sudden cut-back in project funds. Each pack contained 1) fact sheets on teenage pregnancy, HIV/AIDS and other STDs, harmful practices facing Kenyan girls, sexual activity among youth, and teenage abortion; 2) a booklet entitled “Supporting Kenyan Youth: A Leaders Guide to Action”; and 3) a poster of facts and figures about adolescent reproductive health. Three “cues for action” were incorporated into the materials:    Speak up publicly in favor of programs that provide appropriate reproductive health information, counseling, and services for youth. Advocate for and support bills and policies that facilitate access to appropriate reproductive health information, counseling, and services for Kenyan youth. Initiate and encourage positive and collaborative youth-related dialogue among a variety of members in society, including political, religious, community, health, education, media, and business leaders. The Strategy Pack was pretested with key leaders and gate keepers and modified accordingly. Some of the resulting changes affected format, content, and level of detail. The revised Strategy Pack was distributed through workshops and regional leader conferences to district network youth advocates, national and regional leaders, national legislators, officers from the Ministries of Health and Education, medical personnel, and media personnel. 6 The Kenya Youth Initiatives Project The second workshop, held for a week in July 1995, was the District Youth Advocates Training Workshop. This workshop was designed to help develop a national network of youth reproductive health advocates whose work would foster a social climate in which youth reproductive health issues could be discussed openly. Participants received training in how to work through local District Development Committees (DDCs) to get youth issues on the agenda; listen to and educate leaders about youth reproductive health issues; and ask for leader commitment to advocate and help initiate youth-related reproductive health activities. DDCs were considered an important strategic target because they provide the forum for all community discussion of serious matters and are attended by community influentials. The Project Advisory Committee established the selection criteria for workshop participants and participated in their selection by visiting the districts for the final interview with candidates. Participants were to be chosen based on their acceptability to their communities, their involvement with youth, their communication and presentation skills, and their level of leadership in district level activities. Forty-six community-based advocates from 37 districts were selected to attend the workshop. They represented a broad and diverse background and included government officials, civic leaders, religious leaders, businessmen, doctors, nurses, chiefs, district development officers, teachers, and youth counselors. Among them were seven young people. Prior to the start of the workshop, participants completed a District Resource Identification form (see Appendix II) to ensure that they were familiar with community leadership structures and local resources. Participants were asked about DDC and Location Development Committee meetings -e.g., who generally attends, what kinds of issues are discussed, how often are meetings held. They were asked to identify youth resources in the community, including any organizations that address youth issues. Finally, participants were asked about influential leaders in their districts and about how they might best be reached by advocacy efforts. The information collected in these forms helped participants organize the knowledge they had about their community and pinpoint informational gaps. The forms were used later in the workshop in the preparation of Personal Action Plans. The Personal Action Plans described the situation of youth in the advocates‟ district, the target audience, advocacy objectives, key messages, and activities and time line. The Action Plans provided a clear focus for individual advocacy activities. Furnished with these action plans as well as the Strategy Pack materials, the youth advocates returned to their districts to begin sensitizing their community leaders to the problems facing Kenyan youth. Implementation The advocacy project had two tiers: national level activities and district level activities. The national level activities were designed to influence policy at the national level. District level efforts were designed to provide an opportunity for communities to address adolescent reproductive health concerns. The objectives of the advocacy initiatives were to:   Get youth on the agenda of discussions at all levels Listen to and educate leaders about youth reproductive health issues 7 The Kenya Youth Initiatives Project  Ask for leaders‟ commitment to speak up on behalf of youth, to initiate interventions responding to the needs of youth, and to support existing youth activities National Level Advocacy. To have the desired impact, the advocacy component of the KYIP needed to reach officials at the highest levels of government and seek their support. Over the course of the project, KYIP advocates were able to meet with the Vice President and several ministers, including the Minister for Health, the Minister of Culture and Social Services, and the Minister for Education. They also reached over 20 members of parliament, the Attorney General, several senior level magistrates, and senior government officials. District Level Advocacy. District level advocates were expected to meet and talk with at least 12 local leaders (personal contact meetings) and also address at least four district-level meetings over the course of the year. They were reimbursed with a small travel allowance for every meeting they attended to facilitate travel and related expenses such as submitting the Advocacy Activity Report (see Appendix III for a sample form). District level meetings were usually in the form of District Development Committee (DDC) meetings. The DDC meetings were an ideal venue for these efforts since they are the seats of the district government and are the occasions at which matters of local concern are addressed. A typical meeting might include the district commissioner, the district officer, and representatives of all government ministries at the district level (e.g. the district population officer, the district medical officer, the district education officer, the district children‟s officer, the district labor officer, the district engineer, etc). Others who attend these meetings include journalists, heads of schools, religious leaders, businessmen, local developers, community groups, and other interested parties. Most significantly, the DDC would also include representatives of key NGOs. Issues discussed might include the need to build additional schools, the need to equip the local clinic, the progress of the local electrification program, a proposal for construction of the new factory, etc. These deliberations provide a context in which the issue of adolescent reproductive health can be raised as a community concern. In addition to attending the DDC meetings, District Advocates were invited to parent-teacher association meetings, church and parish seminars, community rallies, youth club meetings, health workers‟ gatherings, AIDS seminars, farmers‟ association meetings, and other occasions where community groups met. They also addressed crowds during special celebrations such as World Population Day and the Day of the African Child. The meetings that advocates attended often had as many as 80 people participating. Public celebrations and local rallies could have as many as 1500 people in attendance. Personal contact meetings involved only one or two people, depending on the venue and the audience. The details of these meetings were reported on an Advocacy Activity Report form, and meeting minutes were attached where possible. Advocacy at Regional Leaders’ Conferences. The KYIP advocates were also active during the Regional Leaders‟ Conferences, organized by NCPD and the United Nations Population Fund 8 The Kenya Youth Initiatives Project (UNFPA). Held in October and November 1995, these conferences took the place of the National Leaders Population Conference and provided a forum at which Kenya‟s demographic goals and achievements could be deliberated. A total of four regional conferences were held, to cover the whole country and to enable a diversity of perspectives. Each conference lasted two days. About 1200 leaders attended, among them cabinet ministers and members of parliament, local politicians, senior civil servants, members of the judiciary, provincial commissioners, mayors, councillors, chiefs, religious leaders, and heads of community organizations. The theme of the conferences was Population and Sustainable Development. KYIP organizers helped with the planning of the conferences, and Strategy Pack materials were distributed to the attendees. Members from the KYIP Project Advisory Committee and KAPAH were involved in drafting (and later editing and revising) the conference document, Policy on Population and Sustainable Development, in addition to moderating several of the discussions on youth reproductive health. KAPAH representatives in particular were instrumental in focusing discussion on the issue‟s urgency as well as the sensible path towards reform. Issues related to population, family planning, gender, and sex education were all discussed at the conferences. The Sessional Paper on HIV/AIDS was also drafted during this time, with Project Advisory Committee members helping to shape the final document. As a result of the efforts of the KYIP team, youth reproductive health was pushed high on the deliberations at these conferences. At the end of the deliberations, it was clear that a youth reproductive health policy was needed. Other Support Activities. Other advocacy activities included meetings with religious leaders, government officials, local NGOs, and the media. For example, in July 1995, the KYIP participated in and contributed funding to a national youth workshop for the National Council of Churches of Kenya (NCCK). The workshop was attended by over 100 young people and nearly 400 members of the clergy including bishops and senior ministers. The KYIP team presented the participants with information about the KYIP and how it is working to address the needs of youth in Kenya. At the end of the workshop, NCCK committed to support the move to introduce family life education in schools. This was an important partnership since NCCK represents the majority of the Protestant churches in Kenya. In May 1996, the KYIP team collaborated with KAPAH on a workshop to sensitize officials from several government ministries including the Ministry of Education, Ministry of Health, and Ministry of Culture and Social Services. Participants were asked to identify existing gaps they would fill in the area of adolescent reproductive health. Working in groups, participants developed a “school speaker” program, a proposal where speakers were identified and trained to give talks on adolescent reproductive health to youth in schools. Participants received the Strategy Pack materials, and there were several presentations focusing on the urgency and scope of the problem. In July 1996, KYIP again worked with KAPAH to host a special luncheon for twelve key legislators and members of parliament. The team presented statistics on the consequences of adolescent sexual behavior and the policy and legislative environment for youth in Kenya. At the end of the meeting, members recommended that the presentation be made at a bigger forum, involving more members of parliament. Participants also promised immediate action and in fact on return to the parliament session that afternoon, one of the legislators tabelled a motion on two issues: 1) why the government The Kenya Youth Initiatives Project 9 did not have an adolescent reproductive health policy, and 2) whether legislators were truly aware of how grave the adolescent reproductive health problem was in Kenya. These questions were gazetted in the parliament discussion document, the HANSARD. Evaluation Findings The scale and novelty of the KYIP interventions made this a challenging project to evaluate. Many players were involved, and some of the important advocacy activities occurred ad hoc to take advantage of opportunities that presented themselves. Some of the evaluation required responses from the leaders themselves, a particularly difficult group to get data from. However, using information from several sources, an assessment of the program‟s impact can be attempted. There were three main strategies to evaluate the advocacy activities: a questionnaire in the Strategy Pack distributed at the Regional Leaders Conferences; District Advocacy Activity Report forms; and documentation of informal interviews and comments from leaders at various conferences and gatherings and from the media. Results from the Regional Leaders’ Conferences. A questionnaire was included in the Strategy Packs given to leaders at the Regional Leaders Conferences. It sought to determine the leader‟s opinion of the materials in the package and how he/she would use them. Participants were usually given the Strategy Pack the day before and asked to return the questionnaire the following day. A total of 418 questionnaires were completed. While self-selection of respondents cannot be ruled out, the data suggest that the Strategy Packs were well-received. As shown in Figure 2.1, upwards of 90 percent of the leaders liked the materials and said they would use them in community meetings. More than 90 percent also said they would like to be more involved in youth issues. Interest was such that there were requests that the Strategy Pack be translated into Kiswahili to enable wider use at the local level. Thus the advocacy activities appear to have heightened awareness of and interest in youth reproductive health issues. During the Conferences, the KYIP team recorded the proceedings to gauge the mood of the deliberations. The overall impression was that nearly all the leaders agreed that reform must come soon given the implications for future growth and development. One of the participants echoed the overall sentiment: “Our youth must be given accurate information on population and their sexuality to enable them to live responsible lives”. Assistant Minister, Kisumu Province meeting. 10 The Kenya Youth Initiatives Project The Kenya Youth Initiatives Project 11 These sentiments were supported by others who recognized the role of parents: “We must discuss [with youth]. We must sit down and teach our children. We are leaving the burden to schools”. Women‟s leader, Coast Province meeting. The open nature of the dialogue allowed for a variety of perspectives. For example, a religious leader expressed a common concern: “Condoms will not help achieve [our] goals.” Pastor, Nairobi meeting. Results from the National Advocates. National level advocates reached many policy makers, including the Vice President, the Minister of Health, the Minister for Education, and the Minister of Social Services. In addition, the advocates held sessions with key gate keepers such as assistant ministers, directors of key parastatals, several permanent secretaries, members of the judiciary including the Attorney General, senior civil servants, directors of NGOs, and key religious leaders. One of the key outcomes of these efforts is the publicizing of the reversal of a practice whereby pregnant schoolgirls were expelled and their education thereby terminated. As a result of KYIP advocacy efforts, the new law received more coverage, and the Minister for Education, despite considerable pressure, was able to hold his ground on this issue. There appears to be less vocal opposition to adolescent reproductive health issues from political leaders in general, again in part because of the KYIP efforts. The advocates had appealed for leaders‟ support, but many politicians admitted that they did not feel comfortable publicly stating their support. The advocates therefore requested that they offer silent support by not attacking the project‟s efforts, and this appears to have made a difference in the degree of vocal opposition. Results from the District Advocates. As discussed earlier, District Advocates were to complete the Advocacy Activity Report at the end of each meeting, although a number of advocates did not follow-up with completing the report. Data were available from 13 of the advocates from 15 districts, and these present a profile of the advocacy activities. Analysis of the data shows that each advocate attended an average of 12 personal contacts and about four meetings over a 12-month period. The overall average number of participants at a meeting was 54 persons; however, meetings ranged from one-to-one meetings to small group meetings to large public gatherings with as many as 1500 people. Based on calculations, nearly 8000 people were reached by these intensive efforts. The audience reached at the advocacy meetings varied, as Figure 2.2 shows. The largest proportion was those attending district development meetings, making up nearly 60 percent of the audience reached. Others included church groups, parents, teachers and students, health care and social work professionals, and other community groups such as farmers unions, women‟s groups, etc. There were also a number of public gatherings during which advocacy activities were conducted. 12 The Kenya Youth Initiatives Project At the meetings, District Advocates were to encourage communities to take action with regard to adolescent reproductive health and to keep youth on the agenda at their various deliberations. The data suggest that the overwhelming majority of the groups were highly supportive of initiatives to respond to adolescent reproductive health. As presented in Figure 2.3, 84 percent of the groups participating at the meetings were judged being openly supportive of efforts to address the problems, 11 percent were privately supportive, and only 5 percent were noncommittal. None of the groups were opposed to the issues discussed. These findings are particularly significant considering the fact that many politicians are hesitant to publicly advocate for candid education for youth, believing that the public is unsupportive. The level of support was high even among the religious groups, which are often thought to be resistant to providing adolescents with reproductive health information, counseling, and services. The Kenya Youth Initiatives Project 13 At these meetings, participants offered many suggestions regarding how the problems of adolescent reproductive health could be addressed and solved. Proposals included organizing seminars and lectures on reproductive health for parents, youth, local leaders, and other audiences. Some participants suggested that youth be provided with IEC materials, that youth groups be formed to disseminate information to other youth, that youth guidance and counseling centers be established, and that seminars be organized to train parents how to talk with their children. Other groups suggested improving centers for destitute children and providing economic development opportunities for youth. Other suggestions included giving youth a voice, for example by restructuring governing bodies so that youth could be represented. Participants also suggested better intersectoral collaboration, in particular collaboration with the Ministry of Health. Several churches wanted to be involved in the advocacy programs, and one offered its church as a venue where young people could meet. Some groups implemented these suggestions right away -- for example, the PTA meeting in one of the schools in Nyandarua district resolved that a lecture on HIV/AIDS would be arranged before students were dispatched home for the holidays, and this action was implemented. Some advocates were invited back to give further talks - in Siaya district, upon hearing the information from the District Advocate, one of the leaders promptly pulled out his diary and prepared an itinerary for the Advocate to tour the district and speak to others. Some of the leaders made financial commitments to support activities related to youth. After an advocacy session with local Chiefs and Assistant Chiefs, one group of leaders resolved to compile a list of all youth who are not in school so that they could link them to the District Social Development Officer for further assistance. These actions illustrate the range of activities considered feasible in the effort to improve the reproductive health of 14 The Kenya Youth Initiatives Project the young. They also indicate the level of commitment that communities deemed necessary to lasting reform. Many informal comments were documented throughout the advocacy initiative. For example, a local leader in one of the districts said he could relate to these issues since one of his teenage relatives had recently experienced some of the problems discussed. Other participants gave personal testimonials of their experiences dealing with adolescents in their own families. Thus for many participants, these were issues with which they were intimately familiar. In sum, the groups were highly supportive and most leaders resolved to advocate publicly on behalf of youth and to maintain the issue of youth reproductive health on their agendas. Discussion The advocacy component of the KYIP revealed the level of concern on the part of Kenyan leaders over the problem of adolescent reproductive health. Many understand the web of problems that complicates and threatens adolescents in Kenya today, but they are unable to address them appropriately due to lack of information. Once provided with information, many leaders presented suggestions that could be immediately effected. Thus the advocacy strategy of the KYIP was instrumental in moving the debate in an action-oriented direction. Although the activities were seriously affected by the funding cutbacks experienced by the project, the results are nevertheless encouraging. Nearly 10,000 individuals in total were reached by the advocacy efforts. This includes more than 1200 national leaders, among them the vice president and several ministers. Many of these individuals were reached through intensive one-to-one sessions or in small groups. At the district level, almost 8000 leaders and key players were reached by the advocacy efforts. An additional 400 religious leaders and youth were also reached. The multidimensional nature of the advocacy efforts meant that some leaders could have been reached several times, at national and district level activities. Many members of the national press were also reached by these efforts. About 3000 Strategy Packs were distributed nationwide. While these results may reflect a level of nonrespondent bias, nevertheless they provide a rough assessment of the KYIP efforts. In recent months, there have been tangible changes in the policy environment in relation to adolescent reproductive health. While such progress cannot be entirely attributed to the advocacy efforts of the KYIP, it likely that these efforts did contribute to a climate in which adolescent reproductive health issues could be addressed candidly and in a more focussed and informed manner. By providing factual information and statistics about the plight of youth in Kenya, advocates were able to foster a more productive debate. By seeking public commitment from local leaders, the advocates may have furthered the likelihood of action. Because many were invited back time and time again, these advocates are now a resource for their communities. Their efforts have also led to the development of an informal network of people that can participate in advocating for adolescent reproductive health. The advocacy at the national level has also contributed to positive development. There is evidence now that some of the policy makers use statistics from the Strategy Pack when talking about The Kenya Youth Initiatives Project 15 adolescent reproductive health during public meetings. Many national leaders who were privately supportive of adolescent reproductive health programs but were publicly opposed to them for political expediency have since toned down their public opposition. Thus they are less likely to “fan the fire”. There is also evidence that the advocacy efforts that widely publicized the reversal of the schoolgirl expulsion rule (thereby enabling pregnant girls to resume school after delivery) significantly assisted the political leader involved in this ruling. When he began to waiver on the issue, KYIP advocates supported him through the press and other venues, helping him hold his ground on the new decision. There is also an indication that youth-serving organizations are viewed more favorably and that their interventions have become more visible. The advocacy efforts have also contributed to a positive review and revision of the national population policy document clearly in support of provision of information and services to youth. Because NCPD was the main partner in these advocacy efforts, they could, as a result of the support they received on the ground, push farther in their advocacy efforts. A National Reproductive Health Policy is planned by the Ministry of Health to complement the population and development policy documents. Lessons Learned Leaders as parents: It is helpful to recognize that leaders are, in many cases, parents first. Tailoring a message to them in the parental role has powerful consequences. Many leaders interviewed described situations within their own families that resulted from uninformed or misguided adolescent sexual behavior. Such leaders deeply understand the problems confronting Kenyan youth, and an appeal to them as parents serves greatly to focus the issues and clarify practical solutions. Consistent message: It is important to keep the message consistent by ensuring that the same facts and figures are presented in all instances and that advocates are speaking with one voice. The various workshops were critical preparatory activities, guaranteeing that comprehensive and uniform training was provided to all advocates and that they were using the same information. Multiple strategies: Developing a multi-level and multi-phasic national and local strategy contributed greatly to the project‟s success. Targeting national and district audiences as well as various groups and individuals resulted in a diversity of contacts and wide dissemination of messages. Outreach to opposition: KYIP results illustrate the value of outreach efforts to individuals of opposing viewpoints. Many clergy, for example, never disputed the fact sheets distributed throughout the course of the project, and the Catholic Church wanted to be included in the Youth Variety Show because of its emphasis on accurate, relevant information. Clear call to action: Informing leaders of tangible actions they could take was effective. Providing them with information and giving them options regarding what they could do to 16 The Kenya Youth Initiatives Project alleviate the plight of youth was important. Supporting them through the press and other forums empowered them to stay the course. Selection of advocates: The KYIP team was careful to select advocates based on their standing and acceptability to their communities. This enabled the advocates to reach leaders and mobilize communities with ease. The advocacy strategy plans they had developed during the advocacy training workshop further prepared them to return to their districts with specific plans of action. Remuneration and accountability: Providing advocates with a transportation allowance and related expenses was essential, since it recognized their critical and professional contribution. In addition, asking them to complete the Advocacy Activity Sheets enabled better documentation of their activities and better accountability of efforts. Closer follow-up: Many activities of the KYIP were occurring at the same time, making it difficult for the thinly-staffed project staff to keep up. This was especially the case in keeping in contact with District Advocates. This also meant that less information was available to evaluate the project. Thus better follow-up and more rigorous data collection is highly recommended, should funds be available. Funding: It is necessary to have reliable, adequate funding. Materials dissemination for this project suffered due to lack of funds. When materials are critical to the message strategy, this can be a lingering inconvenience. Identifying local resources: Future efforts might link advocates with local resources so that suggestions from the community can be acted upon forthwith. For example, linking advocates with a coalition of health care providers could facilitate health talks at a local school. Linking advocates with legal experts could have provided advice on legal issues that relate to youth. Thus advocates could have cultivated a team of people with whom they could develop solutions. Although the DDC provided most of those resources, a more strategic team assembled in advance of meetings would have been helpful. Planning before implementation: Part of the planning process should include identifying resources other than those locally available early on so that interested parties can be appropriately referred during actual project activities. Anticipating potential alliances outside the community is key to building on the momentum of meetings because no time is lost when resource information is at hand for quick referral. This is especially important when people are traveling long distances to attend meetings and gatherings. Linking participants on the spot to outside resources for a specific action would have greatly expedited the KYIP activities. The Kenya Youth Initiatives Project 17 III Education Activities The education and information component of the KYIP led to the creation of two of the most innovative and widely appealing radio programs ever broadcast in Kenya. The programs, Youth Variety Show and Dau La Ujana, were aimed at teaching youth and their parents, seeking to fill the knowledge gaps, promote responsible decision-making, and encourage more open parent-child communication. Focus group discussions, workshops, and communication outputs set the scene for the radio programs, the centerpiece of this part of the initiative. Analysis and Formative Research Initial research was concerned with identifying appropriate messages for youth and parents. The Program for Appropriate Technology in Health (PATH) was contracted to do the formative research and analysis, and 37 focus group discussions were conducted, involving 254 young people (ages 13 to 19) and 98 parents from two urban and three rural regions. Both in-school and out-of-school young people were chosen to participate. Topics addressed by the focus groups included the promotion of good health; decision-making; boy-girl relations; physical, emotional, and social development; communication with parents and peers; schooling and career choices; teenage pregnancy and STDs, including HIV/AIDS; drug and substance abuse; early marriage; and female circumcision (KYIPc 1995). Teenage pregnancy was cited most often as the major problem among youth today. The focus groups also revealed that both young people and parents are concerned about STDs, early dropping out of school, the difficulties of early marriage, the availability and attractiveness of drug and alcohol use, lack of parental guidance during adolescence, and lack of job opportunities. Regarding the use of contraception, male and female youth expressed an awareness of what contraception is but at the same time had very little detailed knowledge of contraceptive methods. In addition, youth and parents acknowledged that they have poor relationships with each other generally and would like to develop skills to improve communication and understanding. The findings from these focus groups were consistent with other research and identified important information gaps to be addressed by the KYIP education and information component. All participants emphasized the need for education and an open exchange of information. Parents wanted education and information so they could effectively interact with adolescents and give them the guidance they require. Young people recognized their need for proper sex education and constructive dialogue on reproductive health issues. A second research effort was the literature review of adolescent sexual and reproductive health in Kenya (KYIPd 1996). The review covered over 60 citations examining various aspects of adolescent reproductive health. Findings revealed that adolescents initiate coitus at an early age, generally engage in unprotected sexual intercourse, and have limited knowledge of issues related to sexuality or contraceptive use. The outcome of this is that adolescent girls become pregnant and many induce abortion out of shame and fear, since most school-aged girls who become pregnant are expelled from school. The social, economic, and health consequences related to lack of education, 18 The Kenya Youth Initiatives Project accurate information, and responsible decision-making lead to significant suffering among the young. The literature review pointed to several activities that could begin addressing the education and information needs of Kenya youth and parents. Chief among these was to improve policies and programs that increase access to family planning and counseling services for youth. Also critical would be sensitizing teachers and policy makers to youth reproductive health issues. And finally, the media was recognized as having an important role to play in delivering accurate information and encouraging open dialogue on the issues. Strategic Design and Materials Development The strategic design of the education component of the KYIP focused on providing youth with accurate information on reproductive health and encouraging responsible sexuality. The theme was that to secure a bright future (education and career success), youth need to get the facts to make responsible life decisions and also need to talk to a trusted adult, such as a parent, or visit a youth center to obtain information on how to avoid pregnancy and STDs, including HIV/AIDS. Three workshops were designed with this theme in view: the Message Design and Materials Development Workshop, the National Drama Training Workshop, and the Orientation Workshop for Youth Counselors. These workshops provided the necessary training and focus to prepare for the initiative‟s unique radio programs. The Message Design and Materials Development Workshop was a one-week workshop. Participants included IEC representatives from youth-serving organizations throughout Kenya. Print, radio, and television materials were drafted and underwent a first pretest during the course of the week. Two booklets for youth were developed, Enjoy, a comic focusing on boy-girl relationships, and Play the Game Right, a factual booklet on pregnancy and STDs. Enjoy follows the experiences of a high school boy and girl as they grow in their relationship and confront the issues of sexual behavior. Play the Game Right provides guidelines for making responsible decisions about sexual behavior and includes clear facts about pregnancy, STDs, and HIV/AIDS. A guide booklet for parents, Were You Ever Nine, was also developed during the workshop. Were You Ever Nine focuses on parent-youth communication, with suggestions for talking to adolescents about growing up, sexuality, pregnancy, STDs and HIV/AIDS. The KYIP printed and distributed 30,000 copies of Enjoy, 7500 of Play the Game Right, and 2500 of Were You Ever Nine. The National Drama Training Workshop was the first national gathering of drama teachers from elementary and high schools in Kenya. The workshop was developed as part of the 1995 Kenya Schools and Colleges National Drama Festival, whose general theme was Youth and Responsible Health Behavior. This was also the title of a newly created class in the festival. Participants in the festival included theater, verse, and dance teachers who were encouraged to integrate issues related to adolescent reproductive health into their drama competitions. Teachers received training during the workshop in areas such as selecting themes for stage and scripting, production, adjudication, communicating through theater, narrative performances, dance, and verse. Action plans for continued training workshops at the district and provincial levels were also developed. The Kenya Youth Initiatives Project 19 A separate two-day orientation was held for adjudicators on how to judge pieces in the new Youth and Responsible Health Behavior class. Competitions were held at the zonal, district, provincial, and national levels, and trophies were awarded to the best drama, dance, and verse competitions in the festival. This is a perpetual cup, and as long as the drama festival continues, the Youth and Responsible Health Behavior class will be held. It was originally intended that the final national winner of the competition would refine the winning piece to professional quality and produce a video recording that could be used to convey information on responsible reproductive health in an entertaining and innovative manner. Due to funding cuts, however, this initiative was never completed. The Orientation Workshop for Youth Counselors was a one-day workshop to prepare counselors to receive youth following the radio programs and to use and distribute the project‟s print materials. The workshop provided information about the radio programs as well as modest training in counseling. The emphasis was on youth-oriented service delivery. This effort was limited in scope but identified a critical area that future interventions should address. Implementation The two radio programs, Youth Variety Show and Dau La Ujana, started broadcasting in March 1995. The Youth Variety Show was an up-beat, hour-long English-language program that aired on Saturday mornings, hosted by the youthful DJ Karani, one of the most popular disc jockeys in East Africa, and Elizabeth Omollo, one of sub-Saharan Africa‟s best-known radio personalities. The program‟s aim was to provide youth with accurate information and link them to services where more information or assistance would be available. A related objective was to encourage the young to get information from good sources, for example trusted adults, since services are limited and often confined to a few geographical areas. Each week‟s program had a panel of adolescent and expert guests to discuss various reproductive health issues. Another regular feature was a mobile van (the “Teen Bus”) that traveled to specific districts in Kenya, recording young people's opinions expressed in dramas, interviews, and panel discussions. The Youth Variety Show also fielded live telephone calls from young people asking questions that were then answered on the air. The first time the show aired, the three phone lines at KBC jammed due to heavy caller traffic. The chairman of KBC was forced to give up his own phone so that more calls could come in. In addition to soliciting feedback from callers, the show‟s producers invited listeners to write to the program to share their impressions. Nearly 350 letters were received within the first six months of the broadcast. The popularity of the Youth Variety Show led to the Teen Bus spin-off weekly column published in the Sunday edition of The East African Standard. Teen Bus featured a topic of the day, letters from young people, and an advice column. It also listed youth centers where young people could seek information and counseling. The column was eventually picked up by NOW, a colorful magazine insert in the Sunday paper, and has become a regular feature in doctors‟ waiting rooms, libraries, and salons. 20 The Kenya Youth Initiatives Project Dau La Ujana (The Boat of Youth), a 15-minute radio drama in Kiswahili, was broadcast on Sunday evenings. The story revolved around Zabibu, a teenage girl who enjoyed a good relationship with her parents. Her parents were supportive of her and were interested in knowing and discussing the challenges she faced. She had a boyfriend, Kweke, whose parents were not as receptive to his problems. The drama presented the experiences of both families, exploring issues such as boy-girl relationships, physical growth and development, teenage pregnancy and abortion, and relationships among young people, their parents, and other adults. The script used humor, idioms, and proverbs to convey messages that might otherwise be culturally offensive. Youth Involvement One of the most important features of implementing the project was a high level of youth involvement. The strategic design began by bringing young people together in focus group discussions to explore their concerns. When the radio broadcasts began, young people were recruited to monitor the programs and provide feedback to the producers, participate in panel discussions with expert guests, and attend the live broadcasts as members of the audience. Call-ins from young people helped shape the agenda of topics discussed in subsequent episodes, and the Teen Bus recordings extended the opportunities for expression and exchange to teens all over the country. In all, this participation by young people in the project gave them a voice to express their own concerns, questions, and needs. The Radio Listener Panels had a unique role in the evolution of the broadcasts. Eleven panels were formed, with five based in Mombasa and six in Nairobi. Panels had between six and eight members and included adolescents aged 10 to 19 and both male and female parents. For the Youth Variety Show, panel members commented on the expert sessions, the musical entertainment, the panel discussion sessions, the phone-ins, the celebrity appearances, and the letters section of the program. For Dau La Ujana, members commented on the range of issues incorporated into the drama. The producers considered these panel member comments representative of listener reaction to the broadcasts and used them to assess the appeal of the various program features and revise the program accordingly. Evaluation Findings In order to assess the impact of the Youth Variety Show and Dau La Ujana, two national household surveys were conducted. The first survey was conducted in December 1995, midway through the broadcasts, serving as a mid-term evaluation. The second survey was conducted in August 1996 and served as a follow-up survey. Known as RhINO Surveys, the surveys were conducted by Research International, a local research marketing firm. The initial evaluation strategy had called for a comprehensive baseline survey examining detailed attitudinal and behavioral attributes of the intended audience, including an extensive assessment of parent-child communication. To this end, a national household survey was conducted in September 1994. However, the follow-up survey had to be abandoned in light of the fiscal situation, and the RhINO surveys were adopted for the evaluation. The Kenya Youth Initiatives Project 21 The RhINO surveys are conducted four times a year. The main consumers of the information are the manufacturing, commercial, and advertising sectors, who use it to evaluate public response to their products. For a fee, organizations can have their questions included in the survey questionnaire and can enter or leave the survey at any time. Thus, the RhINO was considered an efficient and economical way to assess exposure to the campaign‟s radio programs. The RhINO household survey is usually conducted among 1000 men and 1000 women ages 15 and above. About 60 percent of the sample is married. The raw data is weighted to reflect the urbanrural distribution in the country. Most of the interviews (over 80 percent) are conducted in Kiswahili. Generally, about 40 percent of the respondents can be classified as youth, age 24 or under; the remaining 60 percent are classified as adults, age 25 and above. Although the intended audience for the KYIP was youth ages 10 to 19 years, the evaluation is confined to youth ages 1524. This change was necessitated by the financial cutbacks the project suffered mid-way though the interventions, making it cost-prohibitive to do a special survey to interview youth under 15 years of age. In addition to the RhINO household surveys, KYIP evaluators collected statistics from three sentinel clinics that provide reproductive health services to young people. The objective of this activity was to assess exposure to the program and document whether more youth attended the facilities as a result of the radio program‟s on-air promotion of the clinics‟ services. Results from the RhINO household survey. The general characteristics of the respondents to the household survey are presented in Table 3.1. A total of 803 youth were interviewed during the first survey, and 779 were interviewed during the second. Just over 1000 adults were interviewed during both surveys. The sample was evenly split between males and females and generally mirrored the country with regard to urban-rural distribution. 22 The Kenya Youth Initiatives Project Table 3.1 Demographic Characteristics of RhINO Survey Respondents Youth Characteristic Survey 1 (Dec ‘95) 803 Survey 2 (Aug 96) 779 Survey 1 (Dec ‘95) 1197 Adults Survey 2 (Aug 96) 1221 Sample size Gender % Male % Female Residence % Urban % Rural 52.9 47.1 50.3 49.7 55.9 44.1 50.2 49.8 15.9 84.1 20.6 79.4 14.4 85.6 21.2 78.8 Socioeconomic Status 1 % Upper SES % Lower Upper SES % Middle SES %Lower Middle SES % Lower SES Total % 1 4.1 21.7 35.4 27.2 11.7 100 5.5 21.6 32.5 28.0 12.5 100 4.4 19.9 27.9 32.0 15.9 100 4.2 22.0 29.1 29.9 14.8 100 Upper SES includes professionals, senior managers, government officers, lecturers, university graduates, secondary school teachers, owners of large business/farms, etc. Lower Upper SES includes junior/middle managers, foremen, senior clerks, nurses, qualified technicians, owners of large businesses/farms, etc. Middle SES includes skilled workers, e.g., mechanics, carpenters, nongraduate teachers, junior clerks. Lower Middle SES includes semi-skilled personnel, manual workers, cashiers, waiters/stewards, forestry workers, owners of small plots, house servants. Lower SES includes subsistence farmers, irregularly employed unskilled workers, e.g., sweepers, casual workers, laborers, adults with no income. Exposure to the programs. Table 3.2 presents the level of exposure to the Youth Variety Show, showing an increase in listenership over time. In the first survey, 54 percent of young listeners had been listening to the program during the preceding six months; this rose slightly to 56 percent by the time of the second survey. However, listenership among adults increased dramatically from one survey to the next, from 28 percent to 41 percent. This is encouraging since one of the objectives of the program was to reach adults in order to foster parent-child dialogue. Table 3.2 also shows that listenership rose among both males and females as well as among urban and rural respondents. In nearly all cases, males were more likely to listen than females, and urban dwellers were more likely to listen than their rural counterparts. As expected, there was a significant association between listenership and socioeconomic status, indicating that the Youth Variety Show found popularity among middle and upper income groups. This was anticipated, since the show was in English. The Kenya Youth Initiatives Project 23 Table 3.2 Percent of Youth Variety Show Listeners Nationwide1 Youth Characteristic Survey 1 (Dec ‘95) n = 803 54.0 59.7 47.7 56.1 53.6 67.3 70.2 61.1 39.3 31.5 Survey 2 (Aug 96) n = 779 55.9 59.5 52.1 59.7 54.9 70.7 70.3 62.0 44.4 33.9 Survey 1 (Dec ‘95) n = 1197 28.2 29.1 27.1 39.3 26.3 35.1 43.1 34.9 19.2 14.0 Adults Survey 2 (Aug 96) n = 1221 41.1 44.4 37.9 49.8 38.8 71.3 61.4 40.7 36.3 13.2 All Male Female Urban Rural Upper SES Lower Upper SES Middle SES Lower Middle SES Lower SES 1 Listened in preceding six months. Source: JHU/PCS 1997 Figure 3.1 shows exposure to the program by age and indicates that the program was highly popular among youth, the primary intended audience. The younger the audience, the more likely they were to listen to the program. However, the results also show that while listenership rose across all age groups between 1995 and 1996, it declined among 15-17 year olds, the core target 24 The Kenya Youth Initiatives Project group. This may be due to the opening of two other FM radio stations that began to compete with the Youth Variety Show. It suggests that future programs will need to be more attractive and aggressive if they are to retain this audience age group. The data suggest that the Youth Variety Show has a fairly strong following: when asked how often they listened to the program in the month preceding the survey, 22 percent said they had listened to it 3-4 times, about half had listened once or twice, and only a quarter had not listened at all. When asked whether they had recommended the program to others, a full 36 percent of the youth in the second survey said they had, up from 23 percent in the first survey. Adults were even more likely to recommend the program to others: during the first survey, 18 percent had recommended the program to others, and this rose to 34 percent in the second survey, an increase of nearly 100 percent. This suggests that many listeners had become active promoters of the program. During the first survey, respondents were also asked about exposure to Dau La Ujana. These questions were asked only in the first survey, as the program was canceled during the first wave of funding cuts. Nevertheless, the data suggest that the program had a substantial level of appeal, but unlike the Youth Variety Show, interest was almost equal among all age groups (see Figure 3.2). Further results of exposure to Dau La Ujana show that adolescent females were as likely to listen to the program as adolescent males - 38 percent of the females and 40 percent of the males had listened to the program in the six months preceding the survey. Among adults, however, the classic male media dominance was evident, and men were more likely to listen (38 percent) than women (31 The Kenya Youth Initiatives Project 25 percent). There were slight urban-rural differences among listeners, with rural youth slightly more likely to listen to the show (42 percent) than urban youth (37 percent) and adult urban dwellers (39 percent) more likely to listen than adult rural dwellers (30 percent). When examined by the five socioeconomic groupings, Dau La Ujana was most popular among middle income Kenyans, and these were the most likely to listen to the program (46 percent among middle income youth, and 40 percent among middle income adults). The least likely to listen to the program were those in the lowest income group, with only 20 percent of the youth and 23 percent of the adults. Behavior change. Central to the evaluation of a communication intervention is the recognition that a person‟s behavior changes over time and goes through a number of stages. Researchers in behavioral sciences refer to this process as “Steps to Behavior Change.” The five main stages included in this behavior-adoption model are: Awareness, Persuasion, Decision, Implementation, and Confirmation/Advocacy. Communication programs can influence each step as individuals graduate from one stage to the next. Individuals may move rapidly or slowly through each step, remain stalled at any given step, or move back and forth between steps. This model was used to evaluate the impact of the Youth Variety Show. Some of the show‟s objectives were to encourage young people to talk to their parents or other adults, to think about their own behaviors, to write to the program producers, to visit a youth center for more information, or to take other positive steps in relation to responsible sexual behavior. Analysis is confined to the youth sample in the second RhINO survey since they were the primary audience of the intervention and since the 1996 data is the most recent available. In the Steps to Behavior Change analysis, percentages are presented are based on the total sample, to enable an assessment on the entire intended audience and not just those who responded, thus providing a more accurate evaluation of the program. The results are shown in Figure 3.3, based on the August 1996 survey. Fifty six of youth ages 1524 had been listening to the program in the six months preceding the survey. Nearly 19 percent of all the 15-24 year olds (or 34 percent of listeners) spontaneously recommended the program to others, and 14 percent (or 25 percent of listeners) took some action related to reproductive health behavior as a result of listening to the show. About one percent of the youth took a tangible action, including writing the program, visiting a health clinic or visiting a youth center. These figures may not seem significant, but when taken in the context of adolescents and their perceived need and ability to take action, they suggest that the program elicited some positive response. As well, it is possible that those who are not sexually active may not use the information learned from the show until later while others may not be able to visit a youth center because of the limited number of such facilities in Kenya. 26 The Kenya Youth Initiatives Project Cost effectiveness. In order to examine the effectiveness of the Youth Variety Show vis-a-vis the costs incurred, the data on program exposure were converted into numbers of individuals reached. The results are presented in Table 3.3 and are based on the fact that youth ages 15-24 make up 20 percent of Kenya‟s population (NCPD 1997. According to the UN, youth age 15-24 total about 5,990,000 people [UN 1996]). Thus if 56 percent of the 15-24 year olds had been listening to the Youth Variety Show, this translates into 3,354,400 listeners. The local cost of the Youth Variety Show (including research and evaluation, production and broadcasting, and program management) was around $97,000. Thus the average cost per listener was 3 U.S. cents. Likewise, if 19 percent of the 15-24 year olds recommended the show to others, then a total of 1,138,113 youth recommended the show, at a cost of 9 US cents each. Similarly, the cost incurred to lead one youth to take an action related to reproductive health is 12 US cents. Although only 1 percent visited the clinic or wrote the program producers, this translates into 60,000 youth, at a cost of $1.62 per young person. These costs dim when compared to the cost of treating a bout of syphilis, a botched abortion, or the consequences of HIV/AIDS. The Kenya Youth Initiatives Project 27 Table 3.3 Cost-effectiveness of the Youth Variety Show Activity Percent Number Estimated cost per person (US$) 3 cents 9 cents 12 cents $1.62 Been listening to the program Recommended program to others Taken action as a result of show Wrote/called show/visit clinic *conservative estimate due to wording of question Based on youth 15-24 (n=5,990,000 nationwide) Source: Kenya Youth Initiatives Project 56 19 14 1 3,354,400 1,138,100 838,600 59,900 Service statistics and source of referral. Data were gathered from three centers that serve young people. Each day, new clients were interviewed and asked how they learned about the facility. Figure 3.4 shows that radio had become an increasingly important “source of referral” to the clinics. For example, at the inception of the radio program initiative, only 23 percent of first-time clinic visitors cited radio as their main source of referral to the clinic, compared to 48 percent citing friends and 42 percent clinic personnel. By the fourth month of the initiative, June 1995, radio had become one of the main sources of referral, cited by 56 percent of new clients, compared to friends (also cited by 56 percent) and surpassing clinic personnel (cited by 39 percent). Clinic data also allowed insight into whether there had been an increase in the number of young people listening to the radio programs over time. The results suggest a gradual rise in the number of listeners. For example, in March 1995, 39 percent of the youth attending the clinics said they had heard the Youth Variety Show. This rose to 40 percent in April, 51 percent in May, and 71 percent 28 The Kenya Youth Initiatives Project in June (the last month of complete data available). Listenership of Dau La Ujana also rose, from about 3 percent in March to 7 percent in April, 13 percent in May, and 15 percent in June. Letters from listeners. At the end of the Youth Variety Show, listeners were invited to write to the program producers to comment on the program or to ask specific questions. Within six months of the program broadcast, 348 letters had been received from all parts of the country. Most of the letters were from young peoplethe average writer was 20 years old. About 58 percent of the letters came from adolescent men, 40 percent from adolescent women, the remainder from parents. The responses were overwhelmingly positive, as the following excerpts show: "I am a first year student at the University of Nairobi and a keen listener of the Youth Variety Show. I not only enjoy the program but also learn more about social aspects of life . . . ." --Male, university student, Ruiru "I am so encouraged by this program because it really helps a lot. I get to learn by hearing about what is happening to other youth like me and I get to know what to do if it happens to me . . . ." --Female, 21 years, Nakuru "Thank you for presenting us with such an educating, consoling and entertaining program . . ., it is making us feel recognized and cared for . . . ." --Female, 18 years, Kiambu "Thank you for introducing the program. Sincerely speaking, it has helped me understand [life] better than before . . . ." --Male, 20 years, Kisii "Thanks for the Youth Variety Show . . . . Personally, I never fail to listen to the program and I am glad to report that I have learned a lot from it . . . ." --Male, 25 years, Karatina "I take this chance to congratulate you for the excellent program . . . Keep up the spirit!" --Male, 20 years, Nyahururu ". . . . Long live the Youth Variety Show and long live the entire organizers." --Male, 20 years, Nairobi Many of the letters asked for assistance, guidance, or advice on a wide range of matters, a clear reflection of the needs among young people: "I would like for you to include in future programs the right steps to follow when choosing a partner for marriage. This would go a long way in helping the youth who usually choose blindly or out of infatuation . . . ." --Male, 20 years, Nyahururu The Kenya Youth Initiatives Project 29 ". . . my problem is that I am shy to talk to girls . . . . my friends tell me that if I do not smoke bhang [marijuana] I will never make it . . . . my question is: Will I ever make it? I know that bhang is harmful but I am tempted to smoke . . . ." --Male, 19 years, Nakuru ". . . is it a must that one should have a boyfriend? I find it difficult to cope with such people . . . . I feel as if I am not sure of myself." --Female, 19 years, Nairobi "My problem is with my relatives . . . . my relatives want me to be a teacher [but] I feel that this is not my career . . . . They can't even listen to me. When I tell them about my wish they say I am rude and I do not know what I am talking about . . . . They want me to marry a guy I do not like and I am not ready . . . ." --Female, 21 years, Nakuru ". . . I have missed your program since we opened school . . . for us in boarding school, we can't get the message from radio since it is prohibited . . . My suggestion also is that you publish a magazine every month. This will encourage good behavior . . . ." --Male, 17 years, Kangundo ". . . I hear that sperm concentration in one's body can cause backache and I seem to have experienced it . . . . Please tell me if it is true or a lie. And also tell me if consumption of avocado fruit is bad for one's health.” --Male, 23 years, Kajiado "My main problem is that I have pimples . . .” --Male, 18 years, Bukura "My problem is being fat . . . I am even afraid of going outside for fear of what people might say about my body . . ." --Female, 18 years, Nairobi 30 The Kenya Youth Initiatives Project Discussion The data show that the radio programs were effective in reaching both young people and adults. By inviting young people as guests on the program, interviewing them in the field, and inviting and responding to their letters, the programs gave young people a voice and opened a dialogue with them. This was particularly important in Kenya, where young people are often culturally voiceless. There were reports of students‟ asking school principals to schedule assignments around the shows to make time for listening. The results also suggest that the programs, especially the Youth Variety Show, were perhaps effective in motivating young people to go to centers. As noted above, more and more adolescents were citing radio as the main source of information about the clinic, and the Youth Variety Show had done most of the publicity on youth centers. Among young people, the Youth Variety Show appeared to be more popular than Dau La Ujana. More than half the 15- to 24-year-olds listened to the Youth Variety Show, compared with 40 percent who listened to Dau La Ujana. Dau La Ujana, however, seemed to appeal to both young people and adults. Despite being just 15 minutes long, it had already attracted a substantial following. In fact, a recurring comment from the project monitoring panels was that the program was too short. This suggests that with a longer time allotment, it could have become as popular as the Youth Variety Show. However, due to funding cuts, it was eliminated altogether. The programs received a positive response from adults as well. Parents often called the Youth Variety Show, and adolescents monitoring Dau La Ujana said that parents even reminded them to listen to the program. Some parents said they appreciated the program for advising young people while others said the show reminded them of their duties as parents. At a recent mass-media conference for broadcasters throughout Africa, the Kenyan Minister of Information cited the Youth Variety Show as an example of an innovative use of radio. The programs also enabled the KYIP to identify other areas of unmet need. For example, letters from young people suggest that adolescents are interested in information about personal development, marriage, health, careers, and other areas the project can address in future activities. FPAK has recently taken ownership of the Youth Variety Show, and youth advocates all over Kenya are hailing the program as a unique source of unity and focus for youth reproductive health initiatives. The KYIP had originally envisioned that its multimedia approach would produce a unique synergy once the project got underway. The potential for establishing links between the different media was enormous. If all the planned materials had been produced and distributed, the national drama piece finalized in video form, and the radio programs continued, this multimedia approach would have created a highly effective -- and cost-effective -- environment for KYIP activities. Unfortunately, this original vision was darkened by budget cuts midway through the project. The Kenya Youth Initiatives Project 31 Lessons Learned  Radio can meet the large unmet need for information among young people and parents: The radio programs found a way of filling the void of information about topics no other program had addressed previously. They provided information for both adolescents and adults, made referrals, and served as an important tool for broaching sensitive topics of adolescence. The variety show format is a powerful tool for exploring issues: Combining information and entertainment in a program‟s format was highly effective. The flexibility of a variety show allowed for discussion of many topics. Opening phone lines to young people enabled the audience to set the agenda. It also allowed candid dialogue among all ages while safeguarding privacy. Sensitive issues can often be raised most effectively by young people: Young people often want to listen to their peers rather than listening only to adults. Sharing common experiences is a great stimulant to honest dialogue. At the same time, the responses from young people reflected in their letters and phone calls suggest they do also respect the advice and guidance of sincere adults, particularly when in response to their own questions. A strong team is essential: KBC, NCPD, and FPAK provided effective leadership. The media plan outlined discussion topics well in advance of a show, allowing adequate preparation. The radio hosts were experienced with young people and were able to make the programs appealing. The content experts, other program personnel, and the young people themselves played a key role in the success of the program. Without the participation and input of a strong team, the shows could not have produced the effects they did. High quality costs less: Having a proficient production team pays. It leads to quality programming that attracts listeners, commercial advertisers, and donors. The Youth Variety Show is currently exploring corporate sponsorship and has been approached by several interested sponsors.     32 The Kenya Youth Initiatives Project IV Conclusion Societies all over the world grapple with the issues associated with the transition of youth into adulthood and how to address them in effective yet culturally acceptable ways. In Kenya, the urgency of the situation is only just beginning to be felt as a result of the HIV/AIDS pandemic. The current generation of youth represents the country‟s “baby boom”, a consequence of the high fertility rates of the 1970s and 1980s. As HIV/AIDS invades these Kenyan youth, the problem will balloon, with far-reaching implications for all of Kenyan society, simply because of the sheer size of this group. Until recently, the consequences of adolescent sexual behavior have been mostly ignored or downplayed by Kenyan leaders. Fertility is not a worrisome issue for them, nor is the high dropout rate for girls. But the HIV/AIDS crisis now looming has served to draw attention to adolescent sexual behavior and its effects on society. The Kenya Youth Initiatives Project was developed to address adolescent reproductive health needs with emphasis on information, education, and communication as well as the policy environment that now exists. The project focused on three groups: adolescents, parents, and policy makers. The initiative was implemented by a consortium of 26 youth-serving organizations, chaired by the National Council for Population and Development, and managed by the Family Planning Association of Kenya. This pooling of intellectual and physical resources contributed greatly to the success of the project, expanding its network and providing access to a wide array of mutually reinforcing activities. The project‟s advocacy component presented a new and important approach to addressing adolescent reproductive health in Kenya. It was clear from the beginning that to be successful any initiative would have to obtain the cooperation of key gate keepers and policy makers. Hence the KYIP trained a cadre of advocates to meet with policy makers and present them with factual information about Kenya‟s youth. Nearly 10,000 individuals were reached by this initiative, among them the top leadership of the country. Policy makers, evaluation results show, are extremely interested in and concerned about the needs of adolescents. Much of the hostility policy makers might have expressed in opposition to the initiative dissipated once they were approached one-onone. The next round of advocacy efforts should build on this momentum by inviting policy makers to events and keeping them updated on the progress of youth activities. Future efforts can tap the trained, experienced advocates and continue the dialogue with key national and local leaders. Another important component of the project was giving youth a voice. The project began by bringing young people together in FGDs to discuss their needs, interests, and experiences. They appeared on the shows and came to the radio studio for live recordings. Young people also monitored the radio programs and gave feedback to the producers. A special van, nicknamed Teen Bus, was employed to reach youth in other parts of the country so that they too could be part of the live broadcasts. By inviting live telephone call-ins during the shows, the radio programs gave youth a voice, enabling them to set the agenda of the radio programs. Young people were also part of the advocacy teams, meeting with policy makers and raising issues of concern with them. The project‟s focus on quality also contributed to its success. Even though the interventions‟ budget was unexpectedly cut midway through the activities, the focus on quality remained, sacrificing the quantity of materials rather than quality. As a consequence, the advocacy materials were highly popular with policy makers. The high production quality of the Youth Variety Show led to The Kenya Youth Initiatives Project 33 unsolicited interest from Johnson and Johnson (Kenya), who have now become an important corporate partner. The same quality attracted UNFPA, which is now likely to support both the advocacy and education aspects of KYIP. A local bank has printed additional copies of the youth booklets, again a reflection of the appeal the materials have even in corporate circles. The KYIP also showed that quality costs less. Because of the tremendous appeal of the Youth Variety Show, the program reached over 3 million youth listeners with important reproductive health information at a cost of less than $0.03 per listener. The radio programs and print materials recognized that adolescents are not a monolithic group, that some are sexually active and others are not. For example, the broadcast and print messages were appropriate for younger as well as older youth. They did not limit themselves to sexual matters but also covered a variety of other topics, including peer pressure, parent-child relationships, substance use, and career development. Many adults, including parents, called the show during the live broadcast. Callers addressed a wide array of issues ranging from girl-boy relations to depression and suicidal thoughts. The program producers relied on content experts brought in to provide information on the topic of the day. These were often members of the KYIP team, again demonstrating the benefits of the project‟s collaborative nature. The program also addressed the fact that many young people did not know where to go for advice and services. The KYIP met this need by announcing the names and addresses of local clinics on the radio. These names were also published weekly in the Teen Bus newspaper column and project booklets. The project trained health care providers in preparation for interacting with their young clientele. However, these activities were extremely small and should be greatly expanded in the next round of the project. Another consideration in future efforts should be the major shortage of youthfriendly facilities. Program staff could identify fewer than 20 such facilities, indicating the magnitude of the problem. Organizers should work on encouraging health care providers to convert their facilities into youth-serving clinics and make a special effort to be available and welcoming to youth. Recognizing how limited is the number of youth counseling centers now in existence, another key approach to addressing information needs was to encourage adolescents to talk to trusted adults, religious leaders, and others who could provide accurate information and advice. Against the successes of the project rose the unfortunate shadow of budget cuts. The unexpected cuts in funding meant that the quantities of materials that could be produced were drastically reduced. For instance, only 30,000 booklets for youth could be produced, barely enough to cover the needs of a small district. Only 3000 Strategy Packs were produced, well below national needs. Both radio programs went off the air (in the case of Dau La Ujana, permanently) without continued funding. While these actions were unavoidable, they did lower project morale. More importantly, they left empty the void they had begun to fill in the lives of many young people. Also critical was the fact that the financial cuts forced a change in the evaluation strategy, which resulted in the dropping of important components that had been planned. Researchers have found that the most successful interventions are those that allow young people opportunities to practice the skills they learn, through role plays or other interactive activities. One of the letters received by the project was a request from western Kenya for additional copies of the comic booklet; teens there had decided to act it out in a play. Future efforts of the KYIP could build 34 The Kenya Youth Initiatives Project on providing opportunities for youth to interact in such small groups, under the umbrella of a national program. For example, several clubs have already been established around the Youth Variety Show, and these could be further encouraged nationwide. The clubs could read materials together, rehearse and role-play suggested tips together, create a drama group, and develop similar constructive activities. Teen Bus could interview YVS club members throughout the country, and the clubs could liaise with local advocates to develop partnerships. Any number of spin-offs could happen, given the creativity of youth. The KYIP played an important role in the effort to alleviate the problems associated with unhealthy adolescent sexual behavior. While many of the accomplishments of the last few years cannot be attributed entirely to the KYIP, it is believed that the project contributed positively to the debate on adolescent reproductive health and helped significantly in shaping constructive responses at both the national and local levels. Nevertheless, many young people and adults alike remain uninformed about reproductive health. School-provided reproductive health information remains controversial and largely ineffectual, given a curriculum that is extremely shallow as well as deficient. Furthermore, only 10 percent of the approximately 500,000 students leaving primary school go on for secondary education, so school-based sex education is often simply irrelevant. The situation is likewise complicated by the very nature of the modern world. Where traditional rituals once educated the young about appropriate sexual behavior and attendant responsibilities, modern-day pressures and unrealistic and sometimes manipulative images now converge to misguide the young in these matters. Sexuality education is not a new phenomenon. What is new is the absence of an effective cultural transmission of knowledge and respect regarding acceptable sexual behavior. This is a failure Kenyan society can no longer afford. Studies in recent years have shown repeatedly that sexuality education can delay onset of intercourse and increase the likelihood that contraception is used when intercourse begins. Whether traditional or contemporary in form, sexuality education leads to two critical results: restraint in sexual behavior and increased use of contraception and protection against STDs. With the specter of HIV/AIDS looming, these studies underscore the importance of continuing to provide sexuality education. Another benefit is that the behavior change effected among the young can be expected to carry over into adulthood, where mature, responsible adults can make informed decisions. It is clear that much important work remains to be done in the area of youth reproductive health, and KYIP interventions point the way towards lasting reform. References 1. Kenya Youth Initiatives Project (a): Adolescent Reproductive Health: Review of Legislative and Policy Environment in Kenya. Nairobi, Kenya. The Johns Hopkins University Population Communication Services, July 1995. The Kenya Youth Initiatives Project 35 2. Kenya Youth Initiatives Project (b): Adolescent Reproductive Health in Kenya: Results of In-depth Interviews with Policy Makers and Community Leaders. Nairobi, Kenya. The Johns Hopkins University Population Communication Services, January 1995. Kenya Youth Initiatives Project (c): Kenyan Youth and Parents Speak: Are We Listening? Nairobi, Kenya. The Johns Hopkins University Population Communication Services, July 1995. Kenya Youth Initiatives Project (d): Adolescent Reproductive Health in Kenya: A Literature Review. Nairobi, Kenya. The Johns Hopkins University Population Communication Services, July 1995. Kumah, O.M., Shefner, C., Muturi, N., Karueru, J., Gachanja, F. and Mwanzia, N.: Kenya Youth IEC Needs Assessment. Baltimore: Johns Hopkins University Center for Communication Programs, 1992. National Council for Population and Development (NCPD): Sessional Paper No. 1 of 1997 on National Population Policy for Sustainable Development. Nairobi: National Council for Population and Development, Office of the Vice President and Ministry of Planning and National Development, 1997. Population Reference Bureau (PRB): World Population Data Sheet, 1997. Washington, DC: Population Reference Bureau, 1997. The Centre for the Study of Adolescence (CSA): Adolescence in Kenya: The Facts. Nairobi: The Centre for the Study of Adolescence, 1995. 3. 4. 5. 6. 7. 8. 36 The Kenya Youth Initiatives Project Appendix I Strategy Pack Assessment We would appreciate your comments on the material presented in this Strategy Pack. Please fill out this short questionnaire and return it to us. We will use your comments to evaluate the usefulness of the materials. Additional comments would be greatly appreciated and can be written on the back of this page. 1. What are your general impressions of the Strategy Pack? (Please tick only one.) Like it very much __ 2. Like it __ No opinion __ Don‟t like it __ What do you think of the Wall Chart? (Please tick only one.) Like it very much __ Like it __ No opinion __ Don‟t like it __ 3. What do you think of the Fact Sheets? (Please tick only one.) Like it very much __ Like it __ No opinion __ Don‟t like it __ 4. What do you think of the Booklet? (Please tick only one.) Like it very much __ Like it __ No opinion __ Don‟t like it __ 5. Do you think this material is useful? Yes __ No __ Not sure __ Please provide any additional comments you have on the back of this sheet. 6. How might you use this material? (Please check all that apply.) Will show to colleagues __ Will show to friends __ Will show to others (who?)__ Will show at a DDC __ Will show at a community meeting __ Will not use __ Other _________________________________ Not sure __ 7. Does this information make you want to become more involved in youth issues? (Please describe.) ___________________________________________________________________ ___________________________________________________________________ Would you like to receive more information about reproductive health for young people 37 8. The Kenya Youth Initiatives Project Yes __ No __ Not sure __ If you would like to receive additional information, please write your name and address below. ______________________________________________________________________ __ ______________________________________________________________________ __ 9. What is your occupation? ______________________________________________ Thank you for your cooperation. 38 The Kenya Youth Initiatives Project Appendix II KENYA YOUTH INITIATIVE ADVOCACY TRAINING WORKSHOP, JULY 1995 DISTRICT RESOURCE IDENTIFICATION FORM In order to prepare for the advocacy work in your district, you need to be familiar with the leadership structures and community resources available locally. This form is designed to help you identify these resources. Please complete it before you come to the Advocacy Training Workshop. If you do not know the answers to any of the questions, please talk to the appropriate people in your district and find out the answers before you come to the workshop. It is very important that you have as much information as possible, because you will need it to develop your district action plans. BRING THIS FORM WITH YOU TO THE WORKSHOP. I. District Development Committee (DDC) Activities 1a. 1b. 1c. 1d. How often does the DDC in your district meet? When is the next DDC meeting scheduled for (date)? How many people attend the DDC meeting? people times/month Who generally attends the meetings (just list the titles of persons, not their names) 1e. What kinds of issues are discussed at these meetings? II. Location Development Committees (LDCs) Activities 2a. How many district officers (DOs) are there in your district? district officers 2b. 2c. How many locations are there in your district? locations How often are Location Development Committee meetings held in your the various Locations? The Kenya Youth Initiatives Project 39 2d. Where are these meetings held? 2e. Who generally attends the meetings (just list the titles of persons, not their names) 2f. What kinds of issues are discussed? 2g. How many chiefs and assistant chiefs are there in your district? chiefs assistant chiefs III. Youth Resources In The District 3a. List the 5 main organizations in your district that deal with youth issues (e.g. parent-teacher associations, boys brigade etc.) i. ii. iii. iv. v. 3b. Do you have a Youth Officer in your district (perhaps under the Ministry of Culture) 1....Yes 2....No 3c. If there is a Youth Officer, what is his/her main responsibilities? 40 The Kenya Youth Initiatives Project IV. Influential leaders 4a. Who are the 10 or 15 most influential leaders in your district (e.g. members of parliament, women's leaders, religious leaders etc.) i. ii. iii. iv. v. vi. vii. viii. ix. x. 4b. What is the best way to reach these people in your district to inform them about youth issues? The Kenya Youth Initiatives Project 41 KENYA YOUTH INITIATIVE PROJECT Suggested objectives and activities of the youth advocates National level advocates 1. 2. 3. Identify key leaders that are supportive of youth and facilitate their position in local press and other forums Identify "hostile" leaders and convert them, assist them to release statement to press about their new position, help them write position papers as necessary Assist parliamentarians with the drafting of the following bills - penalty system for adults (husbands, parents, chiefs etc.) who marry under-age girls - penalty for female circumcision Present the status of youth (fact sheets) and policies (laws/regulations) to policy makers and other key players (e.g. teachers, lawyers etc.) 4. District-level advocates 1. Activities with the DEC and DDC members - attend at least one DDC and DEC meeting - present facts about youth - inform/educate the DDC of policies/laws related to youth - inform/educate other community leaders of the same, as appropriate - assist the district to include youth issues in the district work plan - lobby to include the youth officer in the DDC 2. Activities with the DOs and chiefs - attend at least one LDC per location - present facts about youth - inform/educate the chiefs of policies/laws related to youth - lobby to include a youth rep in the chief's baraza 3. Activities with youth and youth-serving organizations - collaborate with the district youth officer - introduce youth officer to KYI campaign materials, "train" him/her - attend at least two meetings with a youth serving organization - arm youth with information about laws/policies - encourage youth to lobby for their causes 42 The Kenya Youth Initiatives Project Appendix III THE KENYA YOUTH INITIATIVES PROJECT ADVOCACY ACTIVITY REPORT FORM/1 Advocate‟s Name ____________________________________________________________ District __________________________________________________________________ Name and position of contact ___________________________________________________ Date ____________________________ PERSONAL CONTACTS Person met with ______________________________________________________________ Date _________________________ Give a brief description of the leader‟s stand/position with regard to youth reproductive health issues as you know it before your meeting. (Was he/she hostile to these issues? Sympathetic? silently/openly supportive/unsupportive? indifferent?) Where possible, give examples of actions or statements from the person that led you to this conclusion about them. ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ Briefly summarize the content of your meeting ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ 43 The Kenya Youth Initiatives Project ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ In summary you discussed...(tick the issues you covered) The problems  Unwanted pregnancies  School dropout  STDS  HIV/AIDS  Drug/substance abuse The situation  Youth have no reliable information source  Youth have no appropriate services  There is no policy in place to govern youth reproductive health issues  There are no/not enough programs addressing youth to help them reach health adulthood Leaders commitment  Speak up publicly for the need to provide the youth with reproductive health information, counseling and services.  Advocate for and support bills and policies designed to meet young people‟s needs. 44 The Kenya Youth Initiatives Project  Initiate and encourage programs and activities to address reproductive health needs of young people. In your opinion after your meeting with the leader, he/she (to addressing youth reproductive health issues) 1. Strongly opposed 2. Opposed 3. Indifferent 4. Silently supportive but not willing to come out in the open 5. Supportive and willing to come out openly about it Write any statement he/she made during the meeting to support your conclusion. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Did he/she make any firm commitments on actions he/she would like to take? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Did you leave a set of the materials with the leader? Yes/No The Kenya Youth Initiatives Project 45 THE KENYA YOUTH INITIATIVES PROJECT ADVOCACY ACTIVITY REPORT FORM/2 Advocate‟s Name ____________________________________________________________ District __________________________________________________________________ Name and position of contact ___________________________________________________ Date ____________________________ LEADERS MEETING Date of meeting ______________________________________________________________ Kindly attach a copy of the persons present at the meeting, their designation and with signature against each one. Briefly describe the meetings deliberations - if other issues beside yours were discussed, state them in point form e.g. 1) the district water problem 2) introduction of new policy concerning brewing local beer in the district 3)...etc. Give more detail on the issues regarding youth reproductive health. ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ 46 The Kenya Youth Initiatives Project ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ ____________________________________________________________________________ __ Alternatively, attach a copy of the meetings minutes as recorded by the secretary. In your opinion after your meeting with the leaders, were they (to addressing youth reproductive health issues) 1. Strongly opposed 2. Opposed 3. Indifferent 4. Silently supportive but not willing to come out in the open 5. Supportive and willing to come out openly about it Where divided, give detail how so. Write any statement any member made during the meeting to support your conclusion. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Did they make any firm commitments on actions/follow up activities they would like to take? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ The Kenya Youth Initiatives Project 47 Did you give out the materials during the meeting? Yes/No 48 The Kenya Youth Initiatives Project THE KENYA YOUTH INITIATIVES PROJECT DISTRICT ADVOCACY ACTIVITIES - ASSURANCE STATEMENT For completion by the youth advocate I hereby certify that the information I have given is true and verification may be sought from any of the persons mentioned here in. Signed _____________________________________________ _________________ Date Name (IN FULL) _______________________________________________________________ For completion by District contact I, ______________________________________, acting as the contact person for this district certify that _________________________________ carried out the said advocacy activities. Signed ______________________________________________ __________________ Date Name (IN FULL) _______________________________________________________________ The Kenya Youth Initiatives Project 49 Appendix IV Kenya Youth Initiatives Project LEADERS CONFERENCE ASSESSMENT FORM OCTOBER/NOVEMBER 1995 Conference location Date________ Name of person completing form _______________________________________________________ 1. Roughly how many people attended this conference? Break down by type (e.g. ministers, assistant ministers, PCs, DCs, clergy, women's leaders, youth etc.) Type 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Total Number 2. What general comments were made during the youth session(s)? 50 The Kenya Youth Initiatives Project 3. What were the most compelling statements IN SUPPORT of reproductive health programmes for youth and who made them? (Try and get actual quotes) 4. What were the strongest statements AGAINST reproductive health programmes for youth and who made them? (Try and get actual quotes) 5. How would you assess the general consensus at the meeting - supportive or against reproductive health programmes for youth? 1...Supportive 2...Unsupportive 3...In-between 6. What was the reaction of the audience to the KYIP advocacy materials? What did they like? What did they not like? The Kenya Youth Initiatives Project 51 7. Any other comments? For example, were there any issues that participants were strongly for or against? (continue on reverse if necessary) 52 The Kenya Youth Initiatives Project Appendix V Kenya Youth Initiatives Project RhINO Questions 1. In the past six months, have you listened to the Youth Variety Show that comes on KBC General Service (that is English Service) on Saturday morning? 1....Yes (Go to Q3) 2....No (Go to Q2) 2. The Youth Variety Show is a radio program for young people. It is hosted by Elizabeth Omolo and DJ Karani. It comes on Saturdays between 10.30am and 11.30am on General Service (that is English service). It features various family health topics such as talking with parents, boy-girl relationships, AIDS etc. Young people call in with questions to the speakers. The show also has discussions with young people from various parts of the country. Have you listened to this program? 1....Yes 2....No (go to Q7) 3. How many times have you listened to the program in the past month? Would you say (READ CHOICES): 1....Once 2....Twice 3....Three times or 4....Four or more times? As a result of hearing the show, have you done anything or taken any action related to the issues discussed in the program, e.g. talked to someone (parents, friends, teachers etc.), started to think about the issues discussed, sought help, written to the producers etc.? 1....Yes 2...No (go to Q6) If yes, what did you do? (CIRCLE ALL ACTIONS TAKEN) 1....Talked to someone (who?) 2....Thought more seriously about the issues discussed 3....Called or wrote to the producers of the show 4....Visited a clinic or counseling center 5....Other (specify) 4. 5. 6. Have you recommended the show to anyone? 1....Yes 2...No The Kenya Youth Initiatives Project 53 7. In the past six months, have you listened to the Swahili program called "Dau la Ujana" on KBC National Service (that is Kiswahili Service) on Sundays between 6.15pm and 6.30pm? 1....Yes (stop here) 2....No 8. Dau La Ujana is in Swahili and it comes on Sundays between 6.00pm and 6.15pm on KBC National Service (that is Kiswahili Service). It portrays a typical family as they go through life. Some of the characters include Kwekwe, Zabibu, Fikiri, Mzee Domo etc. Have you listened to this program? 1....Yes 2....No 54 The Kenya Youth Initiatives Project Appendix VI KENYA YOUTH INITIATIVE PROJECT: CENTRE SOURCE OF REFERRAL FORM To be completed by ALL New Clients who visit the centre: Name of Centre _________________________________________ Date _________________ Client Name (optional) __________________________________________________________ Age _______________ Sex M / F Marital Status ______________ In- or Out-of-School (write „IN‟ or „OUT‟) _______Highest Level of Education Completed ____ 1. How did you learn about this particular youth centre? (circle all that apply) 01. 02. 03. 04. 05. 06. 07. 2. Radio TV (What on TV? ____________________________) Newspaper/Print Materials (What specifically?____________________) Youth Centre Personnel CBD/Community Health Worker Friends / Relatives Other (specify ____________________________________________) What brought you to the centre today? (Probe for the MAIN reason the client came to the centre. Do not read any responses to the client. Circle only one answer, if the client reports more than one reason, ask him which was most important and circle). 01. 02. 03. 04. 05. 06. For F.P. counseling For other counseling To get F.P. Methods For recreation To find out about the centre Other reasons (specify) _________________________________ 3. Have you heard a radio programme on KBC general service called “Youth Variety Show” that comes on Saturdays 10:30-11:30 A.M. (circle one) YES / NO (if NO, go to question #5) The Kenya Youth Initiatives Project 55 4. (IF YES) What was the programme about? (PROBE by asking “What else” two times and circle all the appropriate responses that the client recalls. Circle item 08 if the client cannot remember anything about the show) 01. 02. 03. 04. 05. 06. 07. 08. 09. How to improve the communication between parents and young people. How to prevent a teenager from getting pregnant or getting someone pregnant. How to prevent contracting an STD. How to prevent transmission of HIV/AIDS. How to manage a healthy boy/girl relationship. Changes that occur when a young person is growing up. Drug and Alcohol Abuse Cannot remember any messages Other (specify_____________________________________________) 5. Have you heard a Kiswahili radio drama on KBC national service called “Dau La Ujana” that comes on Sunday 10 - 10:15 am? (circle one) YES / NO 6. (IF YES) What was the programme about? (PROBE by asking “What else” two times and circle all the appropriate responses that the client recalls. Circle item 08 if the client cannot remember anything about the show) 01. 02. 03. 04. 05. 06. 07. 08. 09. How to improve the communication between parents and young people. How to prevent a teenager from getting pregnant or getting someone pregnant. How to prevent contracting an STD. How to prevent transmission of HIV/AIDS. How to manage a healthy boy/girl relationship. Changes that occur when a young person is growing up. Drug and alcohol Abuse Cannot remember any messages Other (specify ______________________________________________) 7. Did either of the programmes help you decide to come to the centre today? (circle one) YES / NO (IF YES) Which one? or both? ______________________________________________ Thank you for your cooperation. 56 The Kenya Youth Initiatives Project