Pacific Adolescent Health & Development

1. Pacific Adolescent Health & Development Directors of Public Health in the Pacific: Working Together in Prioritizing Youth Health 23-25 August 2010 Novotel Hotel, Nadi Fiji

2. DAY 1 program • Welcome and Speeches • Self-introductions and Expectations from Directors of Public Health • Objectives of the meeting (presentation 1.1-Dr Asaua Fa’asino) • Overview of AHD in the Pacific (presentation 1.2-Dr G. Malefoasi) • AHD Strategies and actions 2009-2012 (presentation 1.3-Dr A.Fa’asino) • AHD Strategic issues and challenges (presentation 1.4-Dr G.Malefoasi) • Group discussion 1.1 • Feed Back 1.1

3. OBJECTIVES OF THE MEETING Presentation 1.1

4. Objectives of the Meeting (1.1a) • PURPOSE • To update the Directors and Managers of Public Health in the ten countries of the following; • the current AHD strategies and goals and the achievements; • constraints affecting the effective implementation • constraints affecting effective achievements of planned outputs and outcomes • To share proposed visions for a better program management and implementation of the AHD program over the next 3 -5 years. • To agree on practical and feasible ways of re-positioning of the AHD in the mainstream public health in the countries.

5. Objectives of the Meeting (1.1b) • OBJECTIVE(S): By end of the 3 days meetings/ workshop the Directors/ Managers are able to work towards the following parameters: • Understand the concepts and principles of the AHD Strategic Plan 2009-2012 and able to work towards a national AHD Policy and Strategic plan framework for their own programs (a draft AHD Policy and Strategic framework in the next 2 years). • Develop a mainstreaming mechanism for the AHD program in country by drafting a structural and functional frameworkwith clear reporting and HR strategic management for the staff implementing the program. • Develop a management (and admin) arrangement for funding of the program utilizing the current funding and implementation modality at SPC as the agents for implementations and coordination. • Indentify the technical assistance needed for the development of the next steps and recommended changes in the implementation and management of the program.

6. “Statement of Intent in the form communiqué”

7. OVERVIEW OF THE PACIFIC AHD PROGRAM Presentation 1.2

8. Overview of the Pacific AHD program (1.2) • Historical perspective • Strategies & Objectives • The underpinning principles • The Actions-intervention packages • The Achievements • The current status of adolescents in PIC

9. Historical perspective 1994 International commitment ICPD Regional mobilization Realign national priorities MDG • Goals and Objectives : • Build strong partnership • Increase access to RH information • Youth centers • In & out of school SE programs • Peer education-NGO • Reduce teenage & STI (services delivery) 1999-2000 Integration Adolescent Reproductive Health 2000-2003 Effective/ efficient increasing coverage? Adolescent Health & Development 2005 -2008 Gender & Rights Pacific Ministers Signed up Consolidate, strengthen the baseline for expansion Mainstream 2009-2012

10. Pacific AHD Strategic Objectives

12. Actions-interventions In School Family Life Education –Early childhood –F 7 In School Life skilled education In School Sexual and Reproductive Health Community based life skilled Youth Friendly Sexual Reproductive Health Services/ HIV/STI Community intervention through Peer Education

13. The Achievements –10 countries • National and community support • Stakeholders participations -Government, NGOs, FBO and families. • ASRH information and education among adolescents and influential groups through media, community education and outreach • Peer education trained persons and network • Family Life Education (FLE) program • Establishment of Youth Friendly Services (YFS) and expanding access to YFS ASRH. • Capacity building exercises - service providers and program coordinators  • ME mechanisms developed

14. Community based life skilled youth trainings- way of reaching the communities

15. Countries trained life skilled youth as point of engagement with community youths

16. Wide dissemination of ASRH information and education among adolescents and influential groups through media, community education and outreach • Focal points were established for youth to access one on one ASRH information

17. FLE progress in 10 countries

18. Establishment of Youth Friendly Services (YFS) and expanding access to YFS ASRH. Total registered YFS Clinics (52 across 8 countries) Overall target population 0-14 yrs (429,470) 15-24 yrs (768,824) YFS Utilization (for 20 clinics- Kiribati 5 Marshalls 3 Solomon 4 Tuvalu 3 FSM 4 Vanuatu 1. Total target pop for 20 clinics: 10-19 yrs Male 28,265: Female 32,000 15-24 yrs Male 28,265: Female 26,678

19. FEMALE Teens 10-19 yrs

20. Establishment of Youth Friendly Services (YFS) and expanding access to YFS ASRH. MALE 15-24 yrs

21. Establishment of Youth Friendly Services (YFS) and expanding access to YFS ASRH. FEMALE 15-24

22. The current status of adolescents in PIC

29. AHD AHD AHD AHD

30. ADOLESCENT HEALTH & DEVELOPMENT STRATEGIC PLAN 2009-12 & RECOMMENDED ACTIONS Presentation 1.3

31. 2009-2012 Adolescent Health & Development Strategic Plan (1.3)

32. Strategic framework

33. Mission To safeguard and protect the sexual and reproductive health of young people through a holistic sexual reproductive health and development interventions Goal The goal of the AHD Strategic Plan is to increase young people (including adolescents’) access to SRH behavioural change information and to achieve a healthy and a socio-economically satisfying livelihood

34. Immediate Objectives • High level objectives (outcome/ impact): • Reduction in teenage pregnancy rates by half over the next 5-10 years. • Reduction in STI rates among young people by half over the next ten years. • Reduction in new HIV infection rates among young people over the next 5-10 years • Improvement in general health status of young people over the next 5-10 years • Reduce risk and vulnerability of young people to common social problems such as substance abuse, crime and psychosocial problems. • Low level objectives (output): • Increase SRH information and services coverage through effective and efficient program management and delivery at the country levels to the MARYP. • Increase political advocacy and commitment to recognize and empower young people who are MARYP and are marginalized.

35. Guiding principles The guiding principle of the Regional Pacific AHD Programme adopts the UNFPA’s vision[ for adolescents and youth, as quoted below: “A world fit for adolescents and youth is one in which their rights are promoted and protected. It is a world in which girls and boys have optimal opportunities to develop their full potential, to freely express themselves and have their views respected, and to live free of poverty, discrimination and violence” (UNFPA 2006).

36. Outcomes Outcome 1Established supportive Political and policy environment through secured political will and linking population structure and poverty dynamics. Strong arguments for investing in young people will be developed and communicated to national leaders and policy-makers as basis for policy dialogue. Advocacy and Mobilisation efforts will be strengthened to gain an enabling community environment. Outcome 2: Targeted in school adolescents accessed and actively participated in gender-sensitive life skills based reproductive health education through formal and non-formal approaches including school-based Family Life Education. All out of school adolescents and other youths accessed and actively participated through community peer education and life skilled training and other outreach activities including behaviour change communication (BCC) and the use of multi media. Outcome 3Targeted adolescent and youths accessed and actively participated through an expanded and up-scale sexual and reproductive health services for young people. Key actions include defining an essential package of youth-friendly services; supporting clinic facilities; training of service providers; integrating SRH and STI/HIV services; and using multiple delivery channels and effective referral mechanisms. Outcome 4 Work towards effective and efficient programme management and delivery with productive and adequate programme staffing; monitoring and evaluation; health systems strengthening and capacity development; and support for evidence-based programming through operational research. More strategic approach through MARYP mapping and focused interventions.

37. Strategies Strategy 1: Secure political will through advocacy for recognition and empowerment of adolescents and youth through national legislations and policy protections and to create a supportive environment both at the higher political and community levels. Strategy 2: Increase access and coverage to quality behavioural change communication (BCC) to ASRH in the countries. Strategy 3: Consolidate and expand sexual reproductive health services to adolescents and youths through conventional and unconventional modalities such as outreach and hub centres. Strategy 4: Consolidate and strengthen AHD program management at regional and country level with priority to improve operational management in the countries.

38. 7.1. KEY STRATEGY RESULT AREAS 1: SECURING POLITICAL WILL Rationale: The joint AHD programme will work alongside national youth policies and incorporate youth issues in national development plans and poverty reduction strategies. To create a supportive policy environment, strong arguments for investing in young people will be identified, packaged and communicated to national leaders and policy-makers as basis for policy dialogue with ministries of youth, women, education and health Key Result Areas 7.2. KEY STRATEGY RESULT AREA 2: INCREASED ACCESS AND COVERAGE TO BCC ASRH INFORMATION Rationale: Effective information, education and communication are essential for attitudinal and behavioural change. Programmes require better understanding of educational and communication strategies and their application to change attitudes and behaviour. Communication is essential to address responsible sexual behaviour, responsible parenthood, teenage contraception, prevention of STI and HIV, gender-based violence, gender discrimination, male responsibility in SRH, reproductive rights and other related topics

39. 7.3. KEY STRATEGY RESULT AREA 3: CONSOLIDATE AND EXPAND SEXUAL AND REPRODUCTIVE HEALTH SERVICES TO ADOLESCENTS AND YOUTH. • Rationale • Strengthening, expanding Adolescent Sexual and Reproductive Health (ASRH) • Youth-friendly Services (YFS) • Programme factors to support AHD Services • Facility factors, SRH commodities and Guidelines for Youth-friendly services • Service Provider competency and skills • Youth perception of the services provided • Because of differing ages, social background and lifestyles, there is a need to package services that meet the different needs of adolescents at different stages 7.4. KEY STRATEGY RESULT AREA 4: CONSOLIDATE AND STRENGTHEN PROGRAM MANAGEMENT AT AHD REGIONAL OFFICE; AND IMPROVE OPERATIONAL MANAGEMENT AT COUNTRY LEVELS. Rationale To strengthen programme management and delivery and will support human resources for adequate programme staffing; monitoring and evaluation; health systems strengthening and capacity development; and support for evidence-based programming through operational research.

40. KRSA 1: & Recommended Actions • To establish an enhanced Supportive Policy Environment linking population structure and poverty dynamics. Strong arguments for investing in young people will be developed and communicated to national leaders and policy-makers as basis for policy dialogue. • Advocacy and Mobilisation efforts will be strengthened to gain an enabling community environment- strategies. • Consolidating and formulating policies and legislations for rights of young people (including adolescents) to RH information and services

41. KRSA 2 & Recommended Actions 2.1. Review the current prevention strategies; reprioritize; harmonize; and integrate at national level. 2.2 . To strengthen intervention packages that deliver gender-sensitive life skills based reproductive health education through formal and non-formal approaches including school-based Family Life Education. 2.3. Expand FLE in schools regionally where applicable and feasible using lessons learned and best practices from Fiji FLE program. 2.4. Strengthen and consolidate existing peer education strategies, networks, and actions at country levels 2.5. Strengthen community based outreach activities, behaviour change communication (BCC) - Stepping stones and the use of multimedia.

42. KRSA 3 & Recommended Actions 3.1. To consolidate existing community based and school based clinics offering Youth Friendly Services through the following activities 3.2. To strengthen expand and up-scale sexual and reproductive health services for young people. 3.3. Gender mainstreaming of the ASRH interventions through MAYP mapping exercise in countries

43. KRSA 4 & Recommended Actions 4.1. Improve and evidence based strategies: Strategic management and evaluation, wider and inbuilt sustainable advocacy at a very higher level of the Government and the social sector and communities. 4.2. Strengthen political coalition on AHD. 4.3. Aligning to national priorities and plans. 4.4. Program-Based Country intervention: assist countries to shift from project to program based management, implementation and monitoring of AHD. 4.5. Review current AHD prevention strategies: review and analyze and monitor the current intervention packages. 4.6. Multisectoral approaches and partnership with other agencies and civil societies

44. THE STRATEGIC ISSUES, GAPS & CHALLENGES Presentation 1.4

45. Issues/challenges The Strategic issues, gaps & Challenges (1.4i) Many countries over the ten years of the AHD project are still having difficulties to show out right political and policy commitments to the sexual reproductive health of the YOUNG PEOPLE (especially the teens/ adolescents

46. Issues/challenges The Strategic issues, gaps & Challenges (1.4ii) • Recent SGS and DHS studies in the PICTs (2004-2005, 2008) found high risk sexual behavior among young people. • The 2009 MARYP (most at risk young people) mapping exercise in six countries also reiterated the risk behaviors among young people. • FLE / SE coverage limited • Peer Education programs not well utilized • Life skilled enhancement for youths not moving The coverage and impact of the current IEC and behavioral change interventions (ASRH information) are not showing expected results up in the past decade of the project period.

47. Issues/challenges The Strategic issues, gaps & Challenges (1.4iii) • Low coverage- across all centers • Low utilization-both gender & adolescence • 2010 YFS Survey: • Facility • Program management • Service providers • Client satisfactions The AHD centers established by the AHD project over the past ten years are not effectively delivering youth friendly services to the young people (including adolescents) in the countries.

48. Issues/challenges The Strategic issues, gaps & Challenges (1.4iv) • Average Output achievements for 2009- 42% • Average implementation rating for 2009-45 % • Inadequate coordination The AHD project has not been embedded into the national public health system. It is more or less operating vertically as a project type arrangement. Implementation rating for AHD activities below 50%