Evaluation of the CIES Adolescent Program

Prepared by RTI International for review by the United States Agency for International Development (USAID)/Bolivia, this 148-page resource evaluates the Centro de Investigación, Educación y Servicios/Salud Reproductiva (CIES) adolescent sexual and reproductive health (ARSH) programme in Bolivia. CIES is a non-governmental organisation (NGO) whose conceptual framework is based on a commitment to: (1) a primary health care approach to health services; (2) equity between the sexes; and (3) community participation.

A central component of CIES's ARSH programme, described below, is the "Youth Corner" (Rincon Juvenil) in each of the clinic sites that provides a gathering place that enables youth to explore ARSH through exposure to educational materials, discussions, informative games and other activities; orientation and consultation is also offered. Other components of the initiative involve ARSH personnel providing information and education to youth, teachers and student teachers using the Para vivir nuestra sexualidad (PVNS) module. Volunteer youth "replicate" the educational activities with peers in and outside of school, while teachers do the same with students. Teachers hold meetings with parents to sensitise them to the issues through face-to-face discussion, aided by occasional support
from ARSH personnel. CIES also implements the module and sensitisation sessions with
local institutes and associations.

Excerpts from the Executive Summary follow:

Based upon visits to 7 of the nine CIES Adolescent Reproductive and Sexual Health
(ARSH) sites in Bolivia this evaluation found that the program is consistently recognized
in each region for demonstrated capabilities in [information, education, and communication, or IEC] approaches and materials, as well as for supporting collaborative efforts with the Ministries of Health [MoH] and Education as well as municipalities. The exemplary CIES strategy works to improve ARSH not only by focusing directly on adolescents, but also by engaging those who influence adolescent sexual and reproductive health decision-making, such as parents, teachers and health workers.

Success Factors

1. Key to program success resides in the high caliber of ARSH personnel, who receive continual training and refresher courses (twice a year)...
2. A fundamental element that contributes to program quality is the long-term participation of youth volunteers (some of whom have been hired by CIES)...
3. An outstanding achievement of the program that is a result of the effectiveness of
   participatory approaches implemented, is the improved communication on ARSH
   themes among youth, parents, teachers and other program beneficiaries.

Lessons Learned and Best Practices

• ...the quality of personnel in each region is exceptional, and is the principal reason for positive results to date. Regional program supervisors, some who were originally inducted into the program as youth volunteers, and many who are licensed psychologists and educators, are extremely well prepared and deeply committed to their work. The outstanding quality of training received by personnel is a key element, along with the development of validated materials and innovative participatory approaches
  acquired through training...
• The participatory methodology carried out in the teacher and youth trainings that draw on theories of praxis (processes of reflection and analysis) show success as a
  means for participants to gain better self-knowledge, an initial step required for
  broaching the theme of adolescent sexuality and development. Such introductory
  processes work to develop the sensitivity necessary for participants to identify
  with the seriousness of the subject of ARSH and to acquire basic skills to create
  safe environments for reflection and discussion of themes applied in sessions with
  peers, parents, colleagues and others.
• The effectiveness of Youth Corners contribute valuable lessons about the
  importance of providing a space dedicated exclusively to informal and educational meetings by youth and other community members (teachers, university students, parents, general public) focused on ARSH issues and challenges. The Youth Corners effectively serve as ARSH resource centers in an atmosphere of trust where visitors feel they can inquire about sensitive and personal issues with the assurance that information provided is valid and
  questions posed remain confidential with CIES personnel. The central working element of the Youth Corner consists of the constant presence of the program assistant who guides visitors in the selection of reference materials that respond to expressed concerns and interests, while providing orientation in the use of particular materials for self-guided learning or in preparation for the transmission of information to peers, students and family members.
• A key to program strength resides in the excellent institutional relationship with the MoH, based on continual communication, sharing of information, skills, and collaboration in promotional activities...

Recommendations

This evaluation recommends that CIES continue supporting the ARSH Program...

[With regard to structure,]

"CIES should seek a more horizontal and representative structure to better distribute power in decision-making that affects the ARSH program."

[With regard to design,]

"This evaluation recommends that CIES dedicate project efforts to advocacy and promotion of the ARSH program at national and regional levels
to strengthen alliances with municipalities, civic associations as well as state and private organizations. Making known CIES' integrated approach to ARSH would help to
improve its image as more than simply an avenue to contraceptives, as well as clarify its
purpose in the community. Importantly, CIES should make its proven approaches
available to other institutions by reprinting basic, out of print materials that may be sold to help support the program.

...[I]t is recommended that program focus be extended to include populations most in need located in rural areas, periurban neighborhoods, adolescents not in school, youth who work, and other marginalized groups such as gangs and street children...

...It is recommended that CIES specify desired results with regard to behavior modification.

...It is recommended that CIES renovate its methods of orientation, sensitization and teaching with defined emphasis in the development of specific approaches to influence ARSH attitudes and practices that lead to lasting behavior change. This will require more technical support to train and guide regional program personnel...

CIES should comprehensively bring together the ARSH IEC program with the Adolescent Friendly clinic services evenly in all regional sites to improve program integrity and effectiveness. Integration is possible with increased communication ensured by implementation of regularly scheduled coordination, such as meetings to examine achievements, challenges, and propose joint solutions to ARSH problems...

...CIES should improve its qualitative [monitoring & evaluation, or] M&E instruments (pre/post tests, KAP questionnaire) to best measure acquired [knowledge, attitudes, and practices, or] KAP directly related to program interventions. In addition, it is recommended that CIES create valid instruments to record and measure program impact in long-term volunteers, that may take the form of...descriptive techniques that provide rich data on facilitating and limiting factors that enable or prohibit individuals to contribute to improved ARSH.

...It is recommended that CIES provide appropriate technical and supervisory support for ARSH personnel, through which the program could effectively fulfill a permanent role in continual training and advocacy in ARSH issues. In this sense, it is important that CIES make its successful outcomes known publicly in order to garner the community support required to ensure that CIES be included in municipal yearly operative plan..."

Click here for the full resource in English [PDF].

Click here for the full resource in Spanish [PDF].