African Youth Alliance

AYA girl

AYA

INTEGRATION OF ASRH INTO LIVELIHOOD PROGRAMS

Rationale
Increasingly, donors, governments and nongovernmental organizations are coming to understand that for adolescents, sexual and reproductive health behaviors are closely linked with their educational and economic options. Teen pregnancy, abortion, and exposure to HIV/AIDS and other STIs have enormous social and personal impact in terms of education and work opportunities. Conversely, entry into the labor force and economic options during the teen years are critical in determining not only future opportunities for social and economic mobility, but also exposure to health risks, fertility outcomes and overall well-being.

Definition
Livelihood skills development aims to improve capabilities, assets, and activities necessary for young people to earn a living. Activities such as vocational training, income generation and micro-credit scheme are used to promote livelihoods options and skills. Such efforts improve adolescents' economic viability and act as a protective factor against negative reproductive health outcomes. The promise of a bright future can motivate youth to protect their long-term reproductive health by reducing the fatalistic attitude often caused by poverty and helplessness. High unemployment and underemployment are significant issues for all adolescents; however, the stakes are even higher for females and their reproductive health. Girls who work are most often employed as domestic help, oftentimes under exploitative conditions that increase their reproductive health risk. Indeed, this is vividly illustrated by HIV/AIDS rates in most African countries three to six times higher among adolescent females 15 to 19 years of age than those of their male age mates. In contrast, more adequately compensated wage earning under safe working conditions may have important benefits for the health and socioeconomic well-being of girls.

Despite this compelling evidence for linking adolescent sexual and reproductive health with livelihood programs, exactly how this linkage could best be achieved is not clear. Research shows that existing adolescent reproductive health programs that have undertaken livelihood activities have had little success given:

many linked programs are new and interventions are often designed using intuition and experimentationfew efforts have been adequately documented or evaluated for impact
reproductive health and livelihoods emerge from areas with different priorities, philosophies, expertise, resources, and intervention strategies, thereby making it difficult for them to successfully integrate

Linking reproductive health and livelihood skills programs is still a nascent approach. A recent study completed by the International Center for Research on Women (ICRW) concluded that currently most programs are not implementing linked strategies in an optimal fashion and are often achieving, "only marginal effectiveness in meeting both the reproductive health and livelihoods needs of young people." Findings from programs recently evaluated by CEDPA, ICRW, and the Population Council have resulted in the following recommendations. These recommendations will also inform the African Youth Alliance's livelihoods strategy —

Develop approaches that link reproductive health and livelihoods beyond micro-level programmatic efforts to create institutional and policy change at the meso and macro levelsBuild more effective toolkits that go beyond gender-based traditional skills and incorporate knowledge of market assessments and opportunities
Build alliances and design activities that can be evaluated for impact and replication

Key Program Elements
AYA's mandate is to scale-up and institutionalize adolescent sexual and reproductive health (ASRH) while building on lessons learned internationally, both in AYA countries and elsewhere. After examination of its mandate and available resources, and cognizant of the fundamental connection between sexual and reproductive health and livelihoods in the lives of adolescents, AYA has decided to undertake a two-pronged approach —

Integrating ASRH activities with the wide existing network of livelihood programs for adolescents
Advocating for increased recognition and funding support for research-based, gender-sensitive, and market-driven livelihoods programs for youth, as well as for improved linkages between the two ASRH and livelihoods

Numerous organizations and programs with decades of combined experience are working to provide vocational skills to young people in AYA project countries and districts. In Tanzania, for example, the government has set up 629 vocational centers which offer 34 trades in five programs. The International Youth Foundation, a youth-serving group that provides workplace programs, also supports public and private sector livelihood programs in Tanzania. At the same time in Uganda, at least 105 technical schools, institutes, colleges and private vocational training institutes (VTIs) are registered with the Ministries of Education and Gender, Labor and Social Development. Findings from a recent survey of VTIs within AYA districts revealed that 85% were privately owned, with only the remaining 15% being government owned. Of these privately owned VTIs, approximately 45% of private owners are religious organizations, 36% are individuals, and 19% are owned by other nongovernmentals organizations. Both the Uganda assessment of ASRH needs in VTIs in AYA districts and international literature indicate a major need for strengthening and institutionalizing the ASRH component of these programs.

Integrating ASRH information, skills and services into the multitude of existing livelihood programs will fill this gap and provide a powerful synergistic effect. Taken together, skills for economic self-sufficiency, along with reproductive health information and skills, will better enable youth to lead long, productive and healthy lives. By providing ASRH content to young people already involved in vocational and other training programs, along with national and district level policy and advocacy work to stimulate and strengthen systems that can scale-up and institutionalize both ASRH and livelihoods programs, AYA will be able to have a significant impact among a substantial number of youth, even with limited resources.

Guiding Principles
In collaboration with other stakeholders, PATH and its AYA partners will use the following guiding principles in selecting strategies, activities and organizations for integration —

AYA will not provide direct livelihood skills training; rather, it will place emphasis on strengthening links with public and private sector programs that are already providing skills training or are poised to do so. Selected organizations must have the capacity to conceptualize, implement, and evaluate the proposed activity, and be committee to ASRH information and services.Guided by its own program outcomes, AYA will work with implementing partners to develop an essential ASRH package (primarily pregnancy, STI/HIV, and sexual violence prevents, youth-friendly services and referral) which can be tailored to the specific needs of different student bodies before integration into selected livelihoods programs. Package content will depend on its ability to bring about desired behavior change and demonstrate capacity to reach large numbers of adolescents.Livelihood programs selected for integration of ASRH must not reinforce traditional gender biases (ie, AYA will not select programs where girls learn sewing and boys learn mechanics). Preference will be given to programs that provide creative opportunities for girls.Livelihood programs selected for integration must demonstrate an institutional commitment towards sustainability beyond the scope of the AYA project, even while AYA strives towards building their capacity to plan, implement, and evaluate ASRH programs within their portfolio.
Integration of ASRH into livelihood programs must be complemented by district and national level policy and advocacy strategies aimed at increasing recognition and funding support for research-based, gender-sensitive and market-driven livelihoods programs for youth, as well as for improved linkages between the two disciplines. Advocacy efforts will be directed towards government institutions, funding agencies, NGOs, religious institutions, the private sector, and parents.

Evaluation Methods
Activities in this program area will be monitored and evaluated in coordination with the BCC program activities as well as with the overall AYA evaluation. Needs assessments to determine feasible options for integrating ASRH into existing livelihoods programs will launch the evaluation activities. Young people will be included as much as possible, including participating in the development of a monitoring and evaluation plan for each organization that works to integrate ASRH into livelihood activities.

Basic indicators will include the number of organization and/or centers working to integrate ASRH into livelihoods and the number of ASRH activities conducted by type and number of students reached. Progress on trends in youth knowledge and behavior will be monitored as they relate to the AYA outcomes. A special focus of the evaluation of ASRH's integration into livelihoods will be on institutionalization and sustainability — whether the programs are institutionalized into the centers and organizations and whether they have the capacity to continue to provide ASRH information to livelihood students after the end of the AYA project.