Peer Educator Initiatives in Indonesian Adolescent Reproductive Health Project

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Peer Educator Initiatives in Indonesian
Adolescent Reproductive Health Project

• Empowering Adolescents as
• Peer Educators and Peer Counselors
• A case study of SMPFA project funded by World
  Bank
• (By Mira Fajar, UNESCO Jakarta Office
• Dhaka 27 April 2005)

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Background

• The World Bank in 1997 funded a major
  intervention to improve reproductive health at
  two provinces in Indonesia, central Java and east
  Java called The Safe Motherhood Partnerships and
  Family Approach Project (SMPFA).
• SMPFA included a project to address the needs of
  adolescents for relevant and timely information
  and services to improve their reproductive health

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• Empowering adolescents as Peer Educator (PE) and
  Peer Counselors (PC) was initiated in 2001 in the
  ten selected district of SMPFA project.
• The National Board Coordinator of Family Planning
  (NBCFP) was the key facilitation agency of the
  project, and the conceptual design and training
  of PE and PC was the responsibility of the
  national NGO called Indonesian AIDS Foundation

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• The design model
• It emphasizes networking among PE and PC within a
  sub-districts to promote widespread peer
  communication
• It is designed to link trainees to local health
  centers, rehabilitation centers, various youth
  groups and NGOs
• The network approach provide support and
  reassurance to the young PE

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• It also gives them avenues for referral of
  adolescents with specific problems to
  institutions that have the facilities and
  willingness to help with difficult issues

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Schematic of Five Sectors Collaborating in the
Adolescent Reproductive Health Programs at the
Local Levels, 2001-2003
National Board Coordinator Of Family Planning
ARH Coordination
Education Formal Non-Formal
Religion Religious School-based
NGOs -- LSM
PE/PC Teenage Center
Social Affairs Community Organization
Health Adolescent Friendly Community Health
Clinics
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Activities

• Basic concept
• The basic concept of the activity was to train
  individuals from the adolescent age groups of 10
  to 24 to become Peer Educators (PE) and Peer
  Counselors (PC) for adolescents of junior or
  senior high school age.

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Peer Educators Training

• Sessions were designed to be active, and maintain
  a high degree of interest and concentration among
  the participants.
• The training was designed to give the following
  skills
• - To conduct small group information sessions on
  reproductive health for adolescents

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• To use teaching materials especially developed
  to cover major issues on reproductive health for
  adolescent
• (growing up sexual behavior pregnancy,
  contraception and abortion, sexually transmitted
  infection and HIV/AIDS, abusive behavior and
  violence, gender drug and alcohol abuse)
• To carry out discussions of reproductive health
  issues in schools, community groups and religious
  groups.

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• The PE trainers included
• - experienced medical doctors and psychologist
  from central and local level with a background in
  adolescent issues
• - senior officials from the National Board
  Coordination of Family Planning (NBCFP)
• PE were supervised by professionals recruited
  from cooperating community institutions,
  including medical doctors, psychologist and
  senior teachers.

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Training materials

• The training materials included
• Manuals and texts to be used in sessions with
  adolescents
• Manuals to guide the PE in methods of
  communication and psychological support.

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Peer Counselors Training

• After their assignments to train small group of
  adolescents, the most effective PE were trained
  as PC
• This training was designed to impart some of the
  basic skills needed to help sort out problems
  raised by individual adolescents or their parents

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• The PC were also regarded as people likely to be
  most successful as motivators in community
  meetings.

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During two years implementation (2001-2002)

• There was widespread enthusiasm for the program
  among PE, PC and the adolescents they trained
• The communities had accepted the need for
  increased education on issues of sexuality and
  reproductive health

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• While not stated directly, the establishment of
  local networks open the door for sexually active
  young people to get contraceptive services, and
  for unintended and unwanted pregnancies to be
  referred to safe abortion or adoption services
• The activities of PE and PC have proven
  universally popular among adolescents and
  generally acceptable to parents and community
  leaders.

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Evaluating the concept of Peer Educators

• Basic concept Peer Educators in context
• Peers implies a form of equality, while educators
  implies an essential inequality, at least in
  terms of relative knowledge
• However, it could be argued that the peer
  educators are meant to be model to which the
  adolescents might aspire

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• According to reports from the project
• PE and PC working on the project could not be
  considered real peers for the 15 to 19 year old
  adolescents who were targeted for the first wave
  of the training
• While some PE and PC were from the target age
  group, most were older and some were already
  married and living in a world far from the high
  school playground

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• It is found that
• To become educators and counselors is implying
  people who share a particular youthful style,
  including clothing, slang, musical interests and
  a common interest
• PE and PC must be acceptable to adolescents. They
  are not parents, teachers, religious leaders,
  bureaucrats or police. They are not judging
  behavior of adolescents and they are not distant
  in lifestyle or language

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• The PE and PC should be able to communicate
  easily with youth and serve responsibly as
  advocates and advisers
• It might also useful aim to recruit PE and PC who
  are in the senior classes of school with just
  enough seniority to be credible as role models
  for the younger students, but not so much as to
  appear too authoritative.

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• Through the more open environments created by PE
  and PC in each districts, we encourage young
  people to be more open talking about youth
  sexuality.
• The PE and PC were not trained to provide
  professional services (medical or psychological),
  which they should provide clear and supportive
  directions for young people to obtain assistance
  through network of institutions involved in
  adolescent reproductive health in their area

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• Adolescent Friendly Community Health Clinics
• The trained teachers at schools
• The professional social workers
• Counselors in the local government
• Private medical practitioners

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• Dangerous Practices
• During the project monitoring, there were several
  questions raised about series of traditional and
  modern practices that can pose a threat
• Circumcision
• Traditional herbal preparations
• Unsafe abortion
• Hazing and harassment in schools

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• Dangerous practices are not exclusively
  adolescent reproductive health issues, but they
  do pose problems that need to be addressed openly
  and explicitly in training manuals, group
  discussion and locally public campaigns

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• Issues of Effectiveness Sustainability of
  PE/PC Networking Approaches
• The representatives of the five sectors involved
  in ARH could produce cheap simple guide for use
  by young people, parents and PE and PC
• The National Board Coordinator of Family Planning
  central office could concentrate on the
  preparation of detailed and timely materials on
  ARH to be released to magazines

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• newspapers and other print media at provincial
  and district level
• Ultimately the National Board Coordinator of
  Family Planning, Central Bureau of Statistic and
  other stakeholders have to make an effort to
  compile, analyze and disseminate more and better
  statistical information

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• Involving local NGOs into the networking
  approaches is necessary that they can play
  important role in supporting and maintaining the
  sustainability of PE and PC activities
• Radio talk back program with Q and A (question
  and answer) formats were found in some districts,
  and they were said to be popular. It would be
  useful to explore the role of this program in
  raising the level of information quality.

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Schematic of Five Sectors Collaborating in the
Adolescent Reproductive Health Programs under
Decentralized System 2004
National Board Coordinator of Family Planning
ARH Coordination Activities Teenage Center
Funding Coordination
Health
Education
Adolescent Friendly Community Health Clinics
Formal Non-Formal
NGOs--LSM
PE Training
PC Training
PE/PC TEENAGE CENTER
Social Affairs Community Organizations
Religion Religious School-based