Annual Progress Reports

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					                                                Save the Children US, Himalayan Field Office, Nepal Program
                                                                                               Grant ID 50050
                                          Annual Progress Report
                                         (May 2002- August 2003)

Save the Children, Himalayan Field office, Nepal Program (HFO/N) began implementing Gates funded
Adolescents Reproductive and Sexual Health (ARSH) project since 1999. The current project is phase II of
the Gates funded ARSH project that was implemented between April 1999 and April 2002. While continuing
and strengthening ARSH activities in 16 village development committees (VDCs) and two municipalities in
Kailali, HFO/N has expanded ARSH phase II activities in 3 VDCs in Kanchanpur and 24 VDCs in Siraha
districts, with the funding supports from Bill and Melinda Gates Foundation. In Kailali, SC/US has continued
partnering with Nepal Red Cross Society (NRCS) to implement ARSH phase II activities and has partnered
with Nepal National Social Welfare Association (NNSWA) in Kanchanpur and Indreni Samaj Sewa (INSES)
in Siraha. Project has targeted to cover 21,660 adolescents/youths aged 10 to 19 years old during 2002-2004, this
year it has planned to cover 14,300 adolescents aged 10-19 years from the three impact districts of Nepal.

This report details the activities carried out from May 2002 to August 2003 under the Adolescent
Reproductive and Sexual Health (ARSH) program implemented by Save the Children US, Himalayan Field
Office, Nepal Program. It also summarises major accomplishments, impacts, lessons learned and
constraints of the project during the reporting period.

I. Project Objectives and activities

Goal : Improved the reproductive and sexual health status of adolescents aged 10-19 years.
To meet the above the goal following are the strategic objectives:
Strategic objective 1: Increased use of RSH services
Strategic objective 2: Improved RSH behavior.
Following are the intermediate results of the project, the achievement of which leads to achieve strategic
IR 1. Increased availability and accessibility of RSH services
IR 2. Increased quality of ARSH services
IR 3. Improved adolescents knowledge, attitude and skills, related to RSH.

Major activities accomplished
Following is the brief description of major activities accomplished during the reporting period.

1. Peer Educators Basic Training

                                                         2                       Annual Report of ARSH Program
                                             Save the Children US, Himalayan Field Office, Nepal Program
                                                                                         Grant ID 50050
The project has trained 515 peer educators in the three project districts during the reporting period. These
trainings were of seven days and covered issues related to ARSH such as reproductive systems,
pregnancy, menstruation, early marriage and child bearing, STIs, safer sex, communication, roles of peer
educators etc. Various participatory methods were used such as small group discussions, role-play, story
telling, games and other participatory techniques. With the guidance and TA from SC staff, 50 project staff
and schoolteachers who had received a six-day training on peer education TOT during the reporting period
itself facilitated these trainings. Currently, the project has 715 peer educators including 200 Peer Educators
from Phase I of the project. Since the target for the year 2003 is 735, the remaining 20 will be trained in
September this year.
After the training, these Peer educators have begun to hold Youth Action Group (YAG) meetings where
they discuss issues related to RSH, participate in PE meetings and involve in project activities in schools.
Developing schoolteachers as PE trainers was found to be a good strategy in gaining more supports in
implementing ARSH activities in the schools. In addition to that, they have been providing supports to the
project staff in monitoring ARSH activities in the schools.

2. Youth Action Group (YAG) formation and meetings.
YAG meetings are continued in phase II of the project as these are the forum where adolescents can
discuss various issues related to ARSH such as, physical and emotional changes of adolescents, STIs and
HIV\AIDS, sexual violence, early marriage, life skills, menstruation etc. During the reporting period, a total
of 515 new YAG are formed. Adding 200 YAGs who are continued from the phase I, total YAGs in the
project comes to be 715, with 12,395 adolescents as YAG members. Peer educators, who are trained to
facilitate such meetings, conduct these YAG meetings. These members have attended at least one YAG
meeting. Number of meetings per YAG group varies as these were formed during different times of the
reporting period. Peer educators educate the YAG members who could not participate in the meeting
during visits or when they meet them some other times. YAG meetings had been proven an effective
means to mobilize youths and the YAG members have begun to discuss ARSH issues with their parents

3. IEC activities
   Despite the inclusion of RH in school curriculum, these are not well discussed in the classes. One of
    the approaches to address this and increase the accessibility to RH information among school
    students, the project has supported the establishment of IEC corners in 10 schools of the project areas
    as targeted. Supports included a steel cupboard, a large notice board, a letterbox, and some important
    IEC materials related to reproductive health to the schools. A memorandum is signed between the
    schools and partners NGOs, which defines the roles and responsibilities of the school and partner
    NGOs clearly. A permanent committee is formed under the chairmanship of school authorities to
    maintain the IEC corners. The headmaster and teacher sponsored, peer Educators and Child
    Journalist are also involved in the committee as patron and advisors. This committee directly handles
    IEC corners and reports to the Youth Mobilizer of respective area.
   SC/US continued to publish "Yuwa Khulduli" Cartoon series in "Sapatahik" weekly of Kantipur
    Publication. Twenty pieces of Yuwa Khulduli Cartoon series has been mounted (18” * 23” size) and
                                                      3                      Annual Report of ARSH Program
                                            Save the Children US, Himalayan Field Office, Nepal Program
                                                                                        Grant ID 50050
    distributed to Partner NGOs. A total of 20 series of Yuwa Khulduli Cartoon series had been published
    during this quarter.
   Continued to air "Yuwa Khulduli (youth query) radio program once in week through Classic FM. A total
    of 13 program had been aired during this quarter.
   Counseling guideline including a three days curriculum had been developed and distributed to the
    Partner NGOs.

4. Youth Defined Quality (YDQ)

One of the main focuses of ARSH has been the improvement in quality of ARSH services. The current
phase has build on and expanded the quality improvement initiatives which were undertaken during phase I
of the project. Following are the activities done to enhance quality of ARSH services:
Youth Defined Quality (YDQ) was introduced with the concept that adolescents themselves are in a better
position to define their perspectives and expectations on quality. In an effort to enhance the quality
of services, YDQ was expanded in project districts, building on the achievements made and lessons
learned during phase I of the project. YDQ was introduced in 11 health service facilities in Kailali and
Kanchanpur as against the target of 15. Remaining 4 in Siraha will be done September this year.
However, some preparatory and initial works such as; discussion groups with adolescents and health
workers, preliminary contacts etc were done in August.
In Kanchanpur, following a 4 day orientation to partner and SC staff, discussion groups were
held with adolescents and health workers from 4 health facilities. Based on the findings a one day bridging
the gap workshop was done including other influencing members of the community like; Chairperson,
school teachers and parents etc. One Quality Improvement team in each of the 4 health facilities were
formed with health workers as advisors for the team. Meetings with the QI teams came up with the action
plan for quality improvement process.
In Kailali, existing 7 QI teams were revitalized through conducting bridging the gap workshop and
reviewing action plan.

5. Counseling training:
Counseling is considered as one of the strong tools to change behaviors. NRCS and NNSWA provided a
four-day long counseling training to 55 staff from ARSH project and health institutions from June 8 – 11 and
18 – 21 respectively. These included Youth Mobilizers, Supervisors and HP/SHP In-charges and VHWs
and MCHWs. The Staff members of ARSH project and the Government health service providers are
trained on Youth friendly counseling service and they are started providing counseling in the impact areas.
During the reporting period a total of 747 adolescents received counseling services from these service
6. STD Case Management Training
NRCS organized a three day STI case management training to 25 health service providers (13 HP/SHP In-
charges, 11 MCHW and one project staff) from June 16 to 18, 2003. Syndromic approach for STI case
                                                     4                      Annual Report of ARSH Program
                                             Save the Children US, Himalayan Field Office, Nepal Program
                                                                                          Grant ID 50050
management was chosen because of its usefulness in rural areas where there are no lab facilities. The
training was conducted based on National Protocol developed by the Ministry of NRCS provided a copy of
national protocol of Syndromic STI Case management to all participants. During the reporting period 61
adolescents received STI treatment and counseling from health facilities in 16 VDCs in Kailali.
7. Orientation / Interaction sessions
Different orientation programs were done to different stakeholders in the project districts in order to gain
their support for implementation of ARSH. Topics covered during orientations were; introduction of the
project, problems adolescents face, components of the project, the way they could provide supports and
ARSH issues.
During the period under review, a total of 1596 parents, 111 teachers, 134 traditional healers etc were
oriented. Besides these district heads like public health officers, district education officers and health post
incharges from respective districts were also oriented.
These orientations have sensitized stakeholders on ARSH issues and to gain support for the project. Some
teachers organized a mini orientation in the schools during their regular meetings. Besides this, some youth
mobilizers have organized community based orientation sessions in small groups. As a result, YAG
members reporting that their parents showing interest to discuss on ARSH issues. Some of them started
to involve their children in decision-making processes like marriage, education.
8. Child Journalism Training:
A five days journalism training conducted for 64 adolescents from 45 schools of impact areas. The target
Group was a student currently studying in grade 6, 7, 8 grades The training included topics on pro-active
journalism and special methodologies like: sharing examples, practical exercises, Illustrations and
Interactive lectures related to adolescent reproductive and sexual health.
The training was based on practical and participatory methodologies. After the training 181 wall magazines
were published by those Journalist from 45 schools in Kailali & Kanchanpur during this year. Students
have shown interest in reading the wall magazines and in knowing more on ARSH issues.
Creation of supporting environment:
   An Adolescents Health Subcommittee is formed with the initiatives of SC/US during the reporting
    period under the chairmanship of Family Health Division, Department of Health Services, and Ministry
    of Health. This sub committee is represented by 16 INGOs and SC/US is appointed as contact
    organization for the subcommittee.
   District Public Health Officer (DPHO) and District Education officer assigned a point person to support
    ARSH program in the impact areas. This has made it easy to access and distribute IEC materials
    received from UNFPA, FPAN, DPHO and WHO for the newly established IEC Corners in the schools.
    Coordination with DPHO has helped revitalize the YFRHS activities at seven health service center.
   SC partners shared ARSH Phase II activities during the Reproductive Health Coordination Committee
    meetings in respective district health offices. In the meeting DPHO, Director, Regional Health training
    center (RHTC), and other line agencies were present.
                                                      5                      Annual Report of ARSH Program
                                            Save the Children US, Himalayan Field Office, Nepal Program
                                                                                      Grant ID 50050

II. Major accomplishments
   Introduction and expansion of Youth Defined Quality
   Increased service utilization by adolescents
   Peer group mobilization and formation of YAG in newer VDCs.
   IEC / BCC activities
   Formation of a national level Adolescents Health Sub Committee with the initiation of SC/US

III. Lessons Learned
   Peer education and Youth Action Groups are effective approaches for discussions and disseminating
    messages of ARSH for a wide range of adolescents.
   Necessary to form separate groups by age and sex of YAG is important to promote free and
    comfortable discussions among their groups. It is also important to design the guideline according to
    their age, for instance knowledge and intent level of message for the group of (10-12) years aged
    adolescents and message for behavior change for (13-18 and above) years aged adolescents.
   Program Action Plan should be based on school calendar, because target group is in school
    adolescents as well. While in selection of peer educators, it is important to select peer educators
    depending on the project duration, and peer educators selection should be matched with the grades
    of adolescents.

IV. Changes: No significant changes during the reporting period.

V. Challenges
  Difficult to involve all YAG members in the meeting because of expectation of incentive and
     absentees at schools.
  Dropped out of trained PEs due to marriage, change of school and migration.
  Adolescents aged 10-13 years are too young to understand the knowledge given by ARSH program.
     Service utilization will be lesser in this range of adolescents.

VI. Other Sources of Project Support
ARSH project received following additional supports during the reporting period:
   Technical support volunteered by Irina Yacobson from Youthnet.
   Amounts of cash US$ 2085.38 for the program in Siraha is supported by SC Private fund.

                                                     6                     Annual Report of ARSH Program
                                                                                        Save the Children US, Himalayan Field Office, Nepal Program
                                                                                                                                      Grant ID#
                                                           Table 1 - Objectives and Activities
                                                                     (2002 – 2003)

STRATEGIC OBJECTIVES                           INDICATOR                               BASELINE               TARGET                PROGRESS
1. Increased use of RHS services               CPR                                      21 %           60 %
Indicators:                                    % Adolescents who received                 -           -                    THESE   IDICATORS WILL BE
                                               counseling                                                                  MEASURED DURING BASELINE
                                               % Adolescents who received STI           43 %         65 %                  AND FINAL SURVEY. HOWEVER,
                                               treatment                                                                   PLANS ARE UNDERWAY TO
                                                                                                                           ASSESS THESE EVERY 6 MONTHS
2. Improved reproductive and sexual health     CONDOM USE DURING LAST SEXUAL            28 %         50 %                  OR EVERY ONE YEAR USING LQAS
behaviors                                      INTERCOURSE.                                                                FOR MONITORING PURPOSES.

1. Increased accessibility & availability of     # of HP/SHPs with youth               7 HPs                 15 HPs       11
RSH Services.                                    friendly RSH services.                                                    (7 HPS are continued since
                                                                                                                             Phase I)
                                                 # of service providers                  49                    35         25
                                                 trained on YFRSH.

                                                 # of counseling service                 11                    35         25

                                                 # schools with functioning               _                    18         8
                                                 IEC corners.

                                                   # peer educators (                   210                   735         715 ( 210 old PEs: NRCS).
                                                                            Save the Children US, Himalayan Field Office, Nepal Program
                                                                                                                             Grant ID#
                                           # health facilities/HPs/SHPs      _                   15           NA
                                           with regular STI & FP
                                           commodities supply system.
                                          # of service providers trained     -                   25           25
                                          on STIs
2. Increased quality of ARSH services.    # of trained service providers    11                   35           25
                                          providing youth friendly RH
                                          services as per protocol.

                                          % of adolescents satisfied       14%                  25%                (Findings from baseline)
                                          with the RH services from
                                          service providers.

                                          # of Serve Delivery points         7          15                    11
                                          with YDQ
                                          # QI teams formed
3. Improved adolescents knowledge,        % of adolescents who name        42.1%          60%                 (Findings of end line survey in
attitude & skill related to RSH.          at least 3 ways of preventing                                        2004)
                                          HIV/ AIDS.

                                          % of adolescents who name        20%           35%                  (Findings of end line survey in
                                          at least three signs & symptoms                                      2004)
                                          of STI.

                                   Save the Children US, Himalayan Field Office, Nepal Program
                                                                                   Grant ID#
 % of adolescents who list         NT                                (Findings of end line survey in
 verbally options to avoid risky                                      2004)

 % of adolescents who              NT                                (Findings of end in survey in
 reported that their parents/                                         2004)
 guardians discussed ARSH
 issues with them.
 Revitalizing Youth                                                  Adolescents Health
 coordination committee                                               Subcommittee formed
                                                                      A monthly meeting used to
                                                                      held in Family Health
                                                                      Division/Ministry of Health.