Author: Moody, D.
Since 1997, UNICEF and the GRN have been running a Youth Health and Development Programme (YHDP), under the 1997-2001 Programme of Co-operation. The aim of the YHDP is to provide life skills and information to young people that would help them to reduce behaviours that put them at risk of HIV infection. The main intervention under the Life Skills project has been the life skills training activity called "My Future is My Choice" (MFMC) for 15 to 18 year olds, in and out of school. MFMC uses a peer facilitation model, using secondary school graduates, who receive 10 days of training on the MFMC manual. National implementation was scaled up in 1998, and the goal of reaching 100,000 young people by the end of 2001 is likely to be achieved. During 2001, there were 291 peer facilitators, 47 Master Trainers (MT) and 14 Senior Master Trainers (SMT) running and managing the programme.
To support the development of the new GRN-UNICEF Programme of Co-operation (2002-2005), the assessment objective was to review the current YHDP implementation mechanisms within regions and develop a plan for strengthening the co-ordination and implementation of Youth HIV Prevention activities at regional level; harmonise the links to national structures and existing mechanisms.
Field visits were made to 11 schools in all five regions -- the 4 'O's, Caprivi, Khomas, Omaheke and Erongo Regions. Visits consisted of: meetings and focus group discussions in schools (that have had active MFMC programme operating) with Principals, Senior Teacher, Contact Teachers, School Counsellors and other staff, and school management representatives involved in the schools MFMC programme. Group discussion with the MFMC youth volunteers, facilitators, MTs, SMTs in each of the region were facilitated, involving a total of 66 young people. Interviews were also held with YHDP Regional Committee Chairs in 4 of the regions and YHDP Regional Committee members.
Findings and Conclusions:
Regional YHDP Committees were instigated in 1998 and a process of management operationalisation was undertaken in 1999. The focus on capacity development has resulted in reasonably well-functioning committees with a clear understanding of YHDP mechanisms primarily for the implementation of the MFMC life skills intervention. The long-term commitment of committee members is valued, as is the quality of the Senior Master Trainers (SMTs) in managing the programme.
YHDP Committees have clear Terms of Reference (TOR) for the management and implementation of 'My Future is My Choice'. This was facilitated through the development and implementation of project management working notes, which are updated on an annual basis to reflect changes in project implementation. The project management notes provide information on the recruitment and support of volunteers, monitoring and evaluation, budget planning and management. Youth volunteers working as Master Trainers (MTs) and Senior Master Trainers (SMTs) manage the programme on a daily basis, supporting facilitators and undertaking monitoring and evaluation.
Regional AIDS Coordinating Committees (RACOC) are the co-ordinating bodies for HIV and AIDS activities in the region. Formed through the Government's MTPII, each RACOC is chaired by the Regional Governor and is comprised of multi-sectoral membership of representatives of line ministries, regional/town councils and NGOs. The formulation of RACOCs followed the launch of MTPII in late 1999. YHDP committees, by that point, had been functioning in the regions for nearly two years. Although report and feedback links have been developed between the two committees, each committee is continuing to operate parallel mechanisms of planning around HIV prevention activities with young people. MFMC, however, is often one of the main adolescent HIV activities in the regions and YHDP representatives, therefore, can play a substantial role in RACOC. There is a need to formalise horizontal links of the committees and the development of the YHDP Committee role in relation to RACOC.
As a result of the Educational Sector HIV strategic planning, Regional AIDS Committee Education (RACE) committees have been established in each of the 7 educational regions. Proposed membership consists of the Regional Education Officer, Senior School Inspector, Regional School Counsellor, senior advisor teacher, principals and others. RACE committees were formed during 2001 and are currently in the process of formalising operations. The 4 RACE committees visited (Khomas, Ondangwa East, Ondangwa West, and Caprivi) are established with committed members but are currently barely functioning. Appointed members were still unclear about their roles.
MFMC was seen as a welcome programme in the schools as a key input into learning about HIV and sexual health. Although some schools have had other programmes visiting such as Childline 'Yes/No Feeling' programme, AIDS dramas, the 'Girl Child Programme' and TADA clubs; YWCA (peer counselling programme), and Health Unlimited and Oxfam have developed school initiatives in Omaheke, there is no clear linkage between programmes or co-ordination in terms of targeting of schools and activities. The development of a RACE committee provides an opportunity to co-ordinate these and other school-based activities.
Since 1999, YHDP committees have been encouraged by the YHDP National Steering Committee with discussions and directions at YHDP Annual Review Meetings, to develop a regional mapping exercise to record the spread of schools and MFMC coverage; and the location of facilitators in relation to school coverage. Few regions have undertaken the exercise consistently and have not developed systematic mechanism for identifying and prioritising schools for MFMC implementation.
Regions instigate different approaches. Some regions have attempted to contact and offer MFMC programme to all schools (with learners aged 15 and older); other regions have selected schools on a more ad hoc basis such as location, interest of principal or teachers, relationship of facilitators to the school and so on.
Schools can and do approach the YHDP committees to request a MFMC programme, usually if they have had a programme in the past, and often to inquire when the next course will be run. The start-stop nature of the implementation of MFMC programme is a commonly-expressed frustration of the school staff. Schools may receive a MFMC course only once in the year and are concerned that each MFMC course can only reach a maximum of 22 learners, resulting in many learners not having the opportunity to participate.
Circuits and constituencies, however, are large geographical areas with remote schools and limited transport. This results in the neglect of some schools in implementing the programme, and hinders the ability of MTs to undertake monitoring, support, and contact with the school and facilitators.
The staff of the schools visited value the MFMC programme. They like the peer facilitation nature of the programme and generally favour the programme being after school and extra curricular. Learners find facilitators approachable and enjoy being facilitated by a young person.
Although some MFMC volunteers continued to facilitate in the same school, school staff also expressed exasperation that, often, it is a different young person facilitating in the school each time and it is hard to keep track of who the facilitator is or form a relationship with them. Schools also expressed that it was difficult to plan when facilitators just turned up.
The effectiveness of MFMC as an after-school, 'extra-mural' activity was discussed with school management. Some suggestions were made that MFMC should become an in-school programme integrated into the life skills classes. Further discussion revealed that the feasibility of this might be limited. Most schools favoured MFMC as an after-school activity, although they pointed out that it can be difficult for learners to attend and may disrupt after-school study time. This, and the non-compulsory nature of the programme, do lead to drop out of learners. The additional after-school commitment for the contact teachers does, in some cases, reduce the motivation of contact teachers, already over burdened.
School staff were able to articulate their ideal for MFMC facilitators: quality, well-trained facilitators (articulate in English and local language(s)) able to facilitate MFMC programme several times each year, supporting post-MFMC AIDS activities and acting as a resource person able to provide HIV and AIDS materials (leaflets, posters etc.) and able to link to other HIV activities and organisations (MOHSS, for example). Some staff expressed that their ideal facilitator may even be able to support the teachers in some life skills lessons when discussing HIV and sexual health issues. Facilitators with skills could almost become to be seen as experts that the school could use as a resource. Schools also supported the possibility of facilitators providing some time for one-to-one peer counselling with learners.
In order to build up a long-term relationship with the facilitator, school staff expressed that they should have more control over the selection of facilitators to work in their school. Schools felt that they may be able to nominate a suitable candidate for training as a facilitator from their past learners or community, or request facilitators that they have worked with before. School involvement in the selection of facilitator would require the development of a relationship with the contact teacher and between the MT/SMT, YHDP committee and RACE.
Schools do not have a clearly designated role in monitoring and evaluation in terms of the learners learning or of the quality of facilitation. School staff and contact teachers do not have a formal opportunity to undertake evaluation or feedback to YHDP Committee/ M&E committee, MT or SMTs reports (although some YHDP do have teachers as committee members).
Schools have a general opinion that learners are gaining knowledge but the school does not systematically monitor this. Schools do not receive feedback from the facilitators' monitoring and evaluation; nor from the YHDP committee in terms of quarterly reports. Currently, learners complete a pre- and post-course questionnaire to monitor knowledge change during the course; and a baseline attitude questionnaire completed by a random sample of young people to assess level of knowledge. Unfortunately, the data collected for the baseline attitude questionnaire is inconsistent, poorly collected and collated. Data for the pre/post questionnaire is more consistently collected, though it is clear that there are often mistakes in the collection and collation. The inefficient use of these two monitoring mechanisms has meant that an opportunity has been lost for the development of good information systems to support the quality implementation and monitoring of the programme.
YHDP volunteers and committees have been encouraged to recognise the links of the MFMC programme to the provision of youth friendly health services. As part of facilitators' TOR, MFMC facilitators should visit local health clinics and hospitals to assess young people's access to free condoms and inform the health staff of the MFMC activities in the community. Facilitators were also meant to assess the level of access to reproductive health services for young people by acting as 'mystery clients' reporting back to the YHDP committee through the MT. MT was tasked to do the follow up with the health facility to share the assessment findings. The quarterly monitoring data shows that this task has not been completed consistently and it is clear that there is not a good understanding of the importance of these roles and the link to MFMC facilitation.
A new model for MFMC implementation is being proposed through this assessment, building on the success of the programme. Broadly speaking, key developments would be:
These developments and further recommendations are outlined completely in the attached report.
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HIV/AIDS - Prevention
Government of Namibia