Improving the Reproductive Health of Youth in Senegal

Face-to-face exchanges at clinic, community, and school levels were central strategies for addressing (and testing) change in the RH status of young Senegalians. In Louga and St. Louis, clinic- and community-based interventions were offered; St. Louis also introduced a school-based intervention. Intervention activities were conducted for 15 months, with the support of the local people, and with increasing demand from schools as well as from youth management facilities.

• At service delivery points:
  
  MOH staff identified 9 service delivery points in each district and, following a self-assessment exercise, action was undertaken to make them more youth-friendly. For example, a room was allocated, either full-time or part-time, for information, education, and communication (IEC) activities; arrangements for receiving adolescent clients were reorganised in order to enable them to have quick and confidential access to providers; 32 providers were trained, according to the WHO curriculum for health providers, so as to make them more youth-friendly; 11 young personnel called "Aide ADO" were identified and trained to welcome and orient adolescents; and IEC activities were organised within the facility and in the neighbourhood.
• At the community level:
  
  Youth education activities were conducted by 60 peer educators trained in communication for behaviour change techniques, using an education-entertainment curriculum developed for this purpose, "Grandir en Harmonie" (Growing up in Harmony). Peer educators also conducted mass activities and took advantage of the events to make young people and their parents more aware (festivals, cultural weeks, tea-debates). In addition, district staff and peer educators gave talks and messages on local radio 2 or 3 times a week. To improve the environment, adults were made more aware of the programme, and parents' discussions were held in the neighbourhood to increase their knowledge and to enable them to communicate effectively with youth. IEC materials were developed and distributed during the campaign.
• At the school level:
  
  GEEP used a multidisciplinary team to develop a curriculum entitled "Le devenir accompagné". Given the specificity of the school environment, their thinking was that an edu-tainment curriculum, like "Grandir en Harmonie", would be difficult to implement inside the classroom. The strategy that GEEP chose was to reinforce the role of teachers by including RH themes in the normal curricula. The curriculum has been developed for primary, secondary, and high school levels. Twenty-six teachers affiliated with GEEP were trained and supervised. Out-of-class activities were conducted with school peer educators.
  
  
  

  The popularity of community peer educators in the district of St. Louis led to requests from some schools to conduct education sessions on RH, with the agreement of the Inspector of the MOE. Community peer educators conducted sessions in 18 schools with the curriculum "Grandir en Harmonie", using the hour in the afternoon that is usually devoted to "Topics not well understand by youth" in primary schools, and family economy classes in secondary schools.

Youth, Reproductive and Sexual Health.

According to organisers, Senegal is undergoing rapid urbanisation, which is spurring changes in traditional social and family structure. These changes have, in turn, led to a rise in early sexual activity among young adults and increased exposure to unwanted pregnancy and sexually transmitted infections. In Senegal, where 28% of the population is between 10-19 years of age, a renewed focus on RH services appears timely.

Baseline research indicated that community members strongly endorsed improving youth RH but expressed mixed feelings about adolescent sexuality. Religious leaders believed that parents should discuss reproductive health issues openly with their children; but parents lack the knowledge to do so with confidence. Though both parents and young people approve of informing youth about RH, most favor promoting abstinence rather than contraception.

This project was part of a 4-country FRONTIERS operations research study that examined ways to improve RH-related knowledge, attitudes, and behaviour of adolescents; Bangladesh, Mexico, and Kenya were the sites of the related research.

According to indicators, adolescents directly exposed to intervention had better knowledge, attitudes, and behaviour than adolescents who lived in the intervention sites without having being exposed to the programme during its last 12 months. In response, the MOH developed a plan to sustain and scale up elements of the model in other districts. WHO/Senegal and the MOH are providing financial support to sustain activities in intervention areas.