Department of Education Consultative Forum on Peer Education: July 6-8, 2009

1. Department of Education Consultative Forum on Peer Education: July 6-8, 2009 Implementers’ Perspective on Peer Education Dr. Asha Mohamud Youth and HIV Advisor UNFPA, SRO-ESA

2. Presentation Outline • Rationale for Peer Education as a Strategy • Advantages of Effective PE Programmes • Issues and disadvantages of PE Programmes • Overcoming documented weaknesses and scaling up PE Programmes • AYA Approach (Uganda, Tanzania, Botswana, Ghana) • YPEER Approach (Eastern Europe, Middle East

3. Rationale for PE Strategy • Adolescents 13-15/17 identify and compare themselves with their peers to affirm self-image • Peer group defines behavioral code during that peer • Adolescents are more likely to listen to their peer and therefore can pass inaccurate information and rumors or correct and science-based information • Adolescent often discuss sensitive topics such as sexuality, relationships and HIV/AIDS with Peers • Negative peer influence can promote unhealthy behaviors such as drug use, involvement in gangs, early sexual activity, GBV early in life while positive peer influence can promote protective behaviors

4. Rationale for PE Strategy(1/2) •  Objectives of PE Programmes • To affect, knowledge, attitudes and behaviors of adolescents by presenting age appropriate messages in a language that young people understand and in their own settings by their peers; • Counter-act misinformation among young people • Link young people with available services • Provide spaces where young people can congregate and share lessons/information/experiences/materials • PEs reflect the diversity of target audience (in-school youth) and are referred to as educators/Counselors/Actors/Activists/motivators

5. Advantages of Effective ASRH/HIV Prev. PE Programmes • Carried out in places where youth congregate (school, community)–not requiring transport • Quite flexible, rooted in the realities of adolescents • Could be combined with other strategies (BCC ..) • Promotes youth participation and builds positive life skills such self-confidence, assertiveness, leadership, communication for Pes as well as knowledge of ASRH/HIV Prevention issues • creating opportunities for mentoring and future job contracts and enrolment in higher education

6. Advantages of effective PE Programmes (cont.) • PE Programmes can be more cost effective per unit information or service provided to a youth (Mexico example) than adult-led programmes • Evaluations of PE programmes found: • increased levels of knowledge and reports of positive sexual behaviours, including increased condom use to prevent HIV/AIDS, modern contraceptive use at last sex, seeking treatment for STIs, intention to delay first sexual intercourse and avoid getting involved in substance use and sexual violence

7. Issues and disadvantages of PE Programmes • Actual cost of PE programmes underestimated and PEs used to replace staff (Mapping of YSOs in 10 Countries—YSOs reported ratio of 2 PEs to 1 Staff • Effectiveness undermined by high turn over, poor supervision and training; and effect of incentives on peer educator effectiveness and continuation. • Often programmes lack provisions for growth for PEs (who age out) and opportunity to use skills in other settings – e.g professional youth workers

8. Issues and disadvantages for PE Programmes (cont.) • Unemployed individuals remain Pes for up to age 30/40 years still acting as Pes and for younger adolescents including 14/17 year old adolescents! 25/30 as 15/17 year olds • PEs vs. peer counseling—PEs ill-equipped to counsel but still counsel others ..decisions! • Lack of Code of Conduct for PEs (what behaviors are forbidden? Coercive sex, exploitation etc.)

9. Issues and Disadvantages of PE Programmes (Cont.) • PE education vs. youth workers (older adolescents tend to do what inner circle of friends do and not what peers do—so is it peer education still?) (dev.) • Well trained adults and PEs are equally effective • PE Programmes much more effective on PEs themselves than Peer Contacts; • PEs more effective in providing information, commodities (condoms) and referral for services rather than changing other behaviors • Hence large number of PE programmes manage to just raise awareness

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11. Issues and Disadvantages of PE Programmes (Cont.) • Stand alone PE Programme may not be able to address all information, attitudinal shift and behavior change needs of adolescents • Structured peer contact vs informal outreach—no specific performance expectation from the Pes (how many reached per month; what materials distributed, where, any referrals etc.) • PE Programmes often reach older youth & males and less number of girls and younger adolescents (10-14); other disadvantaged youth

12. Sex distribution of beneficiaries (peer contacts by organization) in Ethiopia Note: Data was collected over a 6-week period from mid February to end March

13. Age distribution of beneficiaries by sex (Ethiopia) Note: Data was collected over a 6-week period from mid February to end March

14. Overcoming documented weaknesses and scaling up PE Programmes • African Youth Alliance Approach • Provide in and out of school youth with an essential package of sexuality education (40 hours Attack dose) • Provide structured supportive package (called maintenance dose provided by Pes through set of videos, discussions drama series) • Mass media programme linked to PE programme through listening groups and discussions with the Pes • Referral to youth-friendly services by Pes • Leadership and life skills facilitation tech. for Pes • PEs to fill daily and monthly Peer Contact forms • M&E

15. Scaling up: AYA Outcome demonstrated • Increased service use by peer contacts and peers themselves including antenatal and postnatal care by young women • Increased condom use, treatment of STIs and VCT uptake. • Less number of partners in some settings and countries • Delayed sexual initiation in some settings • Qualitative studies indicated prevention of sexual violence –attribution to PEs??

16. What Approaches were used to Scale Up AYA PE Strategies? • Scaling up: Reaching more youth in more places (within schools, communities, districts, regions etc.) • Four Issues to consider when scaling up! • Whether program has been effective • what components lead to its effectiveness? • How scaling up will affect the program’s impact? dilution Effect? • Whether the increased scale will be sustainable? What is objective of scale up?

17. Four Approaches of Scaling Up • Planned expansion or Franchising using a best or promising practice • Association: reaching large numbers of youth through efforts of multiple agencies/schools/churches • Grafting: integrating a promising/best practice in an existing intervention • Explosion: Large scale mobilization at ones AYA used combination of approaches except explosion

18. Scaling UP PE Programmes:Y-PEER (Youth PE Network) Approach • Y-PEER is a collaborative project initiated by the United Nations Population Fund (UNFPA) and supported by FHI. • Designed to build the capacity of NGOs implementing youth peer education programmes through networks • Developing quality tools and resources to overcome known PE weaknesses • Providing training and holding consultative meetings, with meaningful youth participation throughout. • Started in Eastern Europe, then Middle East and Now in Africa and some Asian Countries

19. Y-PEER Approach Continued • Y-PEER Network at global level achieve the following objectives and outputs: • Strengthened quality and relevance of SRH and HIV/AIDS prevention efforts through delivery of standardized and high quality peer education; • Scale up Y-PEER as a networking mechanism and strategic approach in HIV/AIDS prevention for young people; • Facilitated process of institutionalization of peer education through the Y-PEER approach on a sub-regional and country level; • Strengthened regional capacity to deliver successfully demonstrated program strategies on HIV/AIDS prevention geared at young people at risk; including young sex workers, drug injectors, MSM and PLWHA; • Facilitated integration and application BCC programme for young people;

20. In Conclusion • Peer education is viable sexuality education and BCC approach • It is best when linked to other strategies as a supportive strategy and not a stand alone • Effectiveness can be improved by systematically addressing known weaknesses and using performance based approach • It can be scaled up for maximum impact • Increases youth participation and leadership development—promotes rights of youth!

21. Resources and Tools • Youth Peer Education Toolkit FHI/UNFPA: Performance Improvement: for Managers • Standards for Peer Education Programmes: Checklist • Assessing Quality of Peer Education Programmes • Theatre-based Technique for youth PE: A Training Manual (Ypeer) • Many Useful websites….

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