The effectiveness of youth centres

BACKGROUND
This policy brief provides a summary and key recommendations following a joint research project of the International Planned Parenthood Federation (IPPF) and the London School of Hygiene and Tropical Medicine (LSHTM) on the effectiveness of youth centres. The increasing prominence of adolescents in sexual and reproductive health (SRH) programming is positive, but it is important to identify which policies and programmes are most effective in promoting adolescent health. Youth centres have been popular for many years, and despite two earlier literature reviews which did not identify youth centres as a cost-effective approach to promote the use of SRH services (clinical or non-clinical) by young people1 they have continued to be used. This is the rst time that there has been a rigorous systematic review of the literature on the effectiveness of youth centres2, and this policy brief summarizes lessons learnt from the systematic review, combined with key ndings from three recent case studies of IPPF youth centres in different world regions3. Advocates have proposed that youth centres can offer a safe, non-threatening, youth-friendly environment for provision of SRH services, and can allow services such as contraception to be presented in a way that is both attractive to young people, and acceptable to the community. However, there has been growing concern about the effectiveness and costeffectiveness of youth centres in relation to these objectives, and calls for more rigorous research.

Youth centres are a valuable space for training youth volunteers

KEY POINTS

Overall, youth centres do not appear to be a cost-effective way to increase the use of SRH services by young people, and a relatively expensive approach to increasing their empowerment.

A youth-friendly meeting space can be a vital hub for a strong youth outreach programme involving youth volunteers. This does not have to be a specic youth-only building or room, but does need to be a safe place for young volunteers to meet.

Youth volunteers should be trained to be able to link young people to local, youth-friendly health facilities.

IPPF/Graeme Robertson/Nepal

IPPF/Nancy Durrell McKenna/Swaziland/2011

YOUTH POLICY BRIEF # 01 NOVEMBER 2012

KEY TERMS

A youth centre is a physical room that is youth-friendly and where young people can access information and services such as SRH advice, life-skills and recreational activities. They may include clinical services on-site.
IPPF Springboard Guide, 2006

THE EFFECTIVENESS OF YOUTH CENTRES IN LOW AND MIDDLE-INCOME COUNTRIES FOR PROMOTING THE UTILIZATION OF SRH SERVICES AND YOUTH EMPOWERMENT

A SYSTEMATIC REVIEW
A systematic review of previous studies on the effectiveness of youth centres was undertaken by LSHTM. In total, 11 databases and key organizations websites were searched, including, amongst others, IPPF, UNFPA, UNICEF, Pathnder and the Population Council. A total of 3,769 articles were screened against inclusion criteria designed to identify studies that had evaluated youth centres in low and middle-income countries and that had measured young peoples use of SRH services (whether clinical or non-clinical) and/or empowerment outcomes. 22 studies reporting on 18 youth centre programmes were included in the formal literature review.4

Empowerment is a multidimensional term that can include a variety of different concepts at both an individual and collective level. It is about participation in decision making, but also includes processes that lead people to perceive themselves as able to, and entitled to, make decisions. This study looked at a broad range of outcomes for measuring empowerment.

Most youth centres are used by young people who live locally

KEY FINDINGS

Most youth centres are mainly used by boys and young men, many of whom are older than the target age group. Youth centres are usually used by a relatively small number of young people who live close to the centres. Young men and boys primarily come to use the recreational services, not the SRH services. More young women use the SRH services, but uptake is often low. The impact of youth centres on empowerment outcomes were more difcult to assess because there were so many different ways that studies looked at this outcome. There was some evidence of positive changes in empowerment. However, the evidence for this was not strong. Common barriers to uptake of youth centre services included:

Distance to the youth centre, often linked with restrictions on young peoples time,
particularly for girls

The signicant role of parents as gatekeepers, either allowing or forbidding

attendance

Stigma attached to attending the youth centre because of its association with a
family planning organization.

Most youth centres had a peer education outreach component, which was seen as a key aspect of their work. However, the contribution of the peer educator role was rarely evaluated. Limited cost data were available, and where available showed that providing clinical services through youth centres was expensive per client.

IPPF/Nancy Durrell McKenna/Swaziland/2011

Sexual and reproductive health services provided by youth centres can include a broad range of clinical and nonclinical services: family planning counselling and provision including condom distribution; voluntary counselling and testing (VCT) for HIV; general counselling; and treatment of sexually transmitted infections (STIs).

CASE STUDIES
Different models of IPPF youth centres were visited in Nepal, Swaziland and Peru. Mixed qualitative and quantitative research methods were employed: in-depth interviews with staff, youth volunteers and youth centre users; focus group discussions and participatory workshops with youth volunteers; a review of project documentation and clinic data; and observation of youth centres.

FPAN YOUTH CENTRES IN NEPAL

The youth centres of the Family Planning Association of Nepal (FPAN) are closely integrated into a broader youth forum structure. There is usually one youth forum per FPAN district ofce, made up of representatives of different youth sector groups and drawn from different villages across the district, with a mandatory gender balance of elected young people who represent different sectors: the college and school sector, youth clubs (such as sports clubs), childrens clubs and womens groups. FPAN supports two models of youth centres; youth information centres (YICs) and multi-purpose resource centres (MPRCs). The YICs do not offer clinical services directly, but most of them are located very close to an FPAN clinic. One of the more effective MPRCs visited had a large, well-organised network of youth volunteers, mainly young students, with good representation from across the district. These volunteers attended the youth centre for regular meetings and training sessions, and also volunteered at the clinic as youth counsellors.

WE FOUND:

Commonly, there were a small number of repeat users using the youth centres The youth centres were mainly used by young people living very close to the centre, and often primarily by the same group of in-school young people on their way home from school Those who attended the youth centres for recreational facilities were mainly males (>20 years), and often young men rather than adolescents (1019 years) In terms of empowerment, the youth centres were a valuable space for training youth volunteers if centrally located and both physically and socially accessible to both girls and boys The youth centres offered opportunities for young peoples participation within centre management committees, youth boards, and working groups. These opportunities were generally only taken by a relatively small core group of active youth volunteers or youth action members5 Sustainability can often be a challenge given that the cost and maintenance of equipment for modern and exciting resources can be very hard to sustain, e.g. a cyber cafe or sports equipment.

WHO WAS USING THE CLINICAL SRH FACILITIES ON-SITE? WE FOUND:

Uptake was usually low; an exception was a specialist youth clinic adjacent to a youth centre in Peru, close to the university It was mainly females older than 20 years who used SRH services in all sites, and mainly for maternity and child health services They were often used by volunteers for uncontroversial services like blood pressure and weight measurement rather than for SRH services Encouraging the participation of young people in the activities of the youth centre was sometimes in conict with being able to provide condentiality and privacy for young clients.

THE WAY FORWARD: A NEW GENERATION OF YOUTH WORK

RECOMMENDATIONS FOR FIELD PROGRAMME STAFF

FPAN youth centre, Nepal

Evaluate whether there is a need for a specific youth centre building or whether it might be more efficient and cost-effective to have a multi-purpose training or meeting room in a venue that is easily accessible and suitable, as identified by the local youth volunteers. Use a youth-friendly meeting space as a vital hub for a strong youth outreach programme involving youth volunteers. High quality dynamic staff, who have time allocated for their youth coordinator role, are essential for any youth programme that aims to mobilize young people.

Provide information, education and communication (IEC) resources to support volunteer work in the youth hub. Increasingly, the resource materials and advocacy information are likely to be available via the internet, and therefore access to one or two functioning computers with internet access are a valuable resource for volunteer work. Provide a meeting space for youth volunteers that is accessible for both young men and women. Structures such as youth fora (Nepal) that ensure the election of a mandatory balance of male and female youth from different geographical and social sectors of the population, appear to be a useful way of promoting a more diverse group of volunteers. There is insufficient evidence to support the added value of having clinical services in the same building as the youth centre. Instead, youth outreach programmes must have clear and stronger links to existing locally accessible, youth-friendly community clinics, mobile clinics and branch clinics.

ENDNOTES 1
Senderowitz, J., Reproductive Health Outreach Programs for Young Adults, in FOCUS on Young Adults Research Series. May 31 1997, Pathnder International, Washington DC, and Pathnder International 2001. Advancing Young Adult Reproductive Health: Actions for the Next Decade, End of Program Peport. FOCUS on Young Adults. Washington DC: Pathnder International. Zuurmond, M.A., R.S. Geary, and D.A. Ross, The effectiveness of youth centres in low and middleincome countries for promoting access to sexual and reproductive health services: A systematic review. Studies in Family Planning (in press). Zuurmond, M.A. and D.A. Ross, Evaluation of the effectiveness of youth centres: A Synthesis Report. A joint research project of IPPF and LSHTM. June 2011. The focus of the nal journal publication was exclusively on the utilisation of SRH service and did not include the empowerment outcome. Youth Action Members is the term given to IPPF youth volunteers who follow a training programme.

RECOMMENDATIONS FOR NATIONAL POLICY MAKERS AND PROGRAMME STAFF

4 5

Review all youth centre programmes for their effectiveness and likely costeffectiveness against their stated objectives. For example, if a youth centres objectives are broader youth development and empowerment then relevant outcomes should also be measured. Advocate for high quality youth-friendly health services in all service delivery points, ensuring that all clinical and non-clinical staff are trained in the provision of youthfriendly services. Strengthen the linkages between these services and the educational programmes on offer to young people. Optimize capacity building, training, and support to government and other health service providers on the provision of high quality youth-friendly services. Work with parents at a community level to sensitize them to the needs of young people, and to get their buy in for work with young people. Conduct research with younger adolescents (1014yrs) to better understand how SRH programmes can be most effectively provided to this age group. Ensure that all routine data are age disaggregated by five-year age groups. Conduct research with your defined vulnerable groups to better understand where and how they are able to access SRH programmes.

AUTHORS
Maria Zuurmond, David Ross and Rebecca Geary

ACKNOWLEDGEMENTS
Many thanks to all the staff, volunteers and young people at the Family Planning Association of Nepal (FPAN), the Family Life Association of Swaziland (FLAS), the Instituto Peruano de Paternidad Responsable (INPPARES), and the Instituto de Investigacion Nutricional (IIN). We would also like to thank Gwyn Hainsworth of Pathnder International and Annabel Erulkar of the Population Council. The Youth Centre Effectiveness Research Project was funded by the Ministry of Foreign Affairs of the Netherlands. Published in November 2012 by the International Planned Parenthood Federation IPPF 4 Newhams Row London SE1 3UZ United Kingdom tel + 44 (0)20 7939 8200 fax + 44 (0)20 7939 8300 email info@ippf.org web www.ippf.org UK Registered Charity No. 229476

RECOMMENDATIONS FOR INTERNATIONAL POLICY MAKERS

Develop better indicators to measure the impact of youth participation and empowerment in programmes such as youth centres, at both the individual and community level. Evaluate the effectiveness of peer outreach programmes as a mechanism for engaging with youth and SRH promotion. Consider how information and communication technologies (ICT) can strengthen work with young people and promote the use of SRH services. For example, young people could sign up for a texting service that will remind them of clinical appointments, promote services available, advertise specific youth activities, alert them to relevant news topics, and/or send them health promotion messages.

RECOMMENDATIONS FOR FUNDERS

Ensure that all funded youth programmes include a carefully-designed monitoring and evaluation component, including explicit effectiveness, costing and cost-effectiveness (e.g. cost per client served) components. Encourage research that looks at the effectiveness of outreach work with young people, and how ICT (including internet and mobile phones) can be capitalized on to improve services to this group