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Evaluation database

Evaluation report

2017 Jamaica: Evaluation of the “I Am Alive” Programme for Adolescent Girls Living with HIV



Author: Pauline Brown

Executive summary

With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System (GEROS)". Within this system, an external independent company reviews and rates all evaluation reports. The quality rating scale for evaluation reports is as follows: “Highly Satisfactory”, “Satisfactory”, “Fair” or “Unsatisfactory”. You will find the link to the quality rating below, labelled as ‘Part 2’ of the report, and the executive feedback summary labelled as ‘Part 3’.

Background:

A 2010 exploratory study conducted by Eve for Life  (EFL) in Kingston and St. Andrew revealed several gaps in the government’s programme to prevent HIV transmission from mother to child referred to as the pMTCT programme. The study revealed that many young mothers lacked the information, resources and gender-specific support needed to address their health care needs and faced harsh stigma and discrimination at health clinics and other service delivery points. The young mothers also did not have the skills needed to negotiate sexual relationships, to cope with their HIV status or to parent their children.

EFL piloted a successful intervention in Kingston and St. Andrew to address these needs. Based on that success they desired to roll out the intervention to additional parishes. In collaboration with the Ministry of Health, and with financial support from United Nations Children’s Fund (UNICEF), the roll out was implemented in three high HIV prevalence parishes in North and Western Jamaica in October 2012.

Purpose/Objective:

The 3-year programme titled I Am Alive (IAA) was expected to: i) Increase knowledge on comprehensive sexuality education, including skills-based, HIV and pregnancy prevention education among beneficiaries; ii) Improve service delivery in the prevention of mother to child transmission of HIV (pMTCT) programme through the establishment of two centres of excellence in adolescent sexual and reproductive health; iii a) Improve adherence and follow up of 100 mothers in the pMTCT programme through peer mentorship; and iii b) Improve knowledge and awareness of HIV and pregnancy prevention among 600 teenage mothers who attend maternal and child health facilities in St. Ann and St. James and iv) Improve the quality of life of 40 adolescent mothers to support positive prevention and adherence through income generating and livelihood activities.

Methodology:

A summative (outcomes-based) evaluation of the programme was conducted one year after the programme funding ended to assess programme performance on 13 predetermined indicators and to ascertain programme relevance, effectiveness, efficiency and sustainability.

The mixed-methods evaluation design used baseline and end line survey data collected from random samples of programme graduates, service data from the EFL database, and qualitative data from depth interviews with IAA programme staff, focus group discussions with programme beneficiaries and from key informant interviews with key stakeholders to answer the evaluation questions. Two case studies were also completed. The evaluation will provide evidence for the key strategic partners to inform decisions regarding programme improvement and replication.

Findings and Conclusions:

The findings of the evaluation provide evidence that it is possible for adolescents who have been traumatized by sexual violence, HIV infection and related stigma and discrimination and too early childbearing can, with supportive counselling, education and positive mentorship, become self-confident and self-aware individuals.
 

  • The programme reached 103 adolescents; 39 adolescents graduated and 5 of a projected 9 mentor moms were deployed.
  • Knowledge levels on sexual and reproductive health (SRH) issues improved among the programme’s primary beneficiaries.
  • Contraceptive use at baseline was reported by 78% of the sample compared to 81% at end line.
  • 90% of the baseline survey sample reported condom use at most recent sexual intercourse; compared to 95% of the end line survey sample.       
  • Programme participants experienced an improved quality of life.
  • The programme was effective in helping participants build self-worth, overcome fear of their HIV status and to accept their reality, helped in changing their negative attitudes towards the pMTCT programme and improved their relationships with their children and their partners/spouses.
  • Health care providers trained by EFL reported improved knowledge of how to care for adolescents as well as their attitudes toward adolescent clients. They admit needing additional training in communicating with the adolescent as well as in case management.
  • As with other effective adolescent-focussed programmes, effectiveness comes at a high financial cost. The cost per participant was an estimated JA$276,103 .

Recommendations:

  1. Systems Improvement: Eve for Life has demonstrated, conclusively, its ability reach and positively influence the life trajectory of adolescent mothers and adolescents living with HIV with their empowerment model. Continuation of this programme or replication in other parishes, would be facilitated by:
    1. Improved monitoring and evaluation, by focussing the efforts on one or other group of adolescents.
    2. Relying on technology for improved collection of field service data and case management
    3. Establish a standard financial reporting system that is simple but sufficiently flexible to accommodate donor needs.
  2. Strengthening the Youth Empowerment Model: Vocational Training/ Job Readiness
    Expand transition efforts to encourage and prepare women for transition to job readiness and full womanhood through scholarships and partnerships with existing job training programmes. Collaborate with the Ministry of Labour and Social Security to facilitate the provision of grants and identify sources of micro-financing for young women in the programme to establish small business ventures.
  3. Broadening Advocacy:
    1. Promoting Breastfeeding
      EFL is known for its staunch advocacy in sexual and reproductive health for adolescents and young women. Breastfeeding is an important SRH issue and continues to present a challenge. We recommend that:
      1. EFL seize the opportunity of its relationship with the MoH as well as the existence of the Programme for the Reduction of Child and Infant Mortality (PROMAC) project currently being implemented by the MoH and partners, to increase attention and effort to support breast feeding for HIV+ mothers due to the presence of community norms around breastfeeding being promoted by the MoH.
    2. Training for Ministry of Health Personnel who serve adolescent clients
      The organization should begin to broaden its advocacy to include advocacy for quality service provision through training of health care providers.

Lessons Learned:

Conclusions and Lessons learned: Implementation of this programme provided important lessons for EFL and other agencies engaged in similar work with adolescents.

  1. The evaluation data indicates that there is a proportion of adolescent mothers living with HIV who are not complying with the MoH directive to only feed their children with the supplemental feed provided by the MoH and are mixing breast feed with bottle feed. This practice places the child at risk. 
  2. Non-disclosure of HIV status is a barrier to effective outreach and in-reach.
  3. Cultural diversity is a reality even in a small country like Jamaica. Each community/ parish is different and has different needs and so the approach which works well in one parish may need to be adjusted for effective implementation in another parish.
  4. Models like the one EFL applied in the IAA programme are costly to implement. And although the effectiveness is clear, development practitioners are challenged to support their replication.
  5. It is important to set realistic goals and objectives for behaviour change interventions and programme that target adolescents. The objectives IAA set for itself were perhaps overly ambitious given the scope of the programme, the health issues being addressed and the resources available for monitoring and evaluation.
  6. While EFL’s competence to help traumatised adolescents transition out of fear to self-confidence was demonstrated, the organisation’s facility with helping these newly transitioned young women to become economically empowered is underwhelming.


Full report in PDF

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Report information

Year:
2017

Country/Office:
Jamaica

Region:
LACR

Type:
Evaluation

Theme:
HIV-AIDS

Partners:
Eve For Life, Ministry of Health

Language:
English

Sequence #:
2017/001

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