What I'm Doing Here, Part II: Peer Education & Hope Kit Training

FHI 360 has been funding and monitoring Youth Friendly Health Service (YFHS) activities in collaboration with the Salima District since 2008.  Seventeen health centres throughout the district implement YFHS.  In July 2010, I conducted a training aimed to improve YFHS throughout the district by training health peer educators.  Through funding from FHI 360 and Peace Corps Malawi, 51 participants were trained in peer education techniques and facilitation.  Thirty-four youth and 17 service providers from the 17 health centres in Salima district attended the five day course.

The training comprised a variety of health topics with a special focus on HIV/AIDS prevention.  Each participant received a Hope Kit, a HIV prevention tool that provides and emphasizes activities and actions that individuals or groups of people can take as steps towards HIV prevention or mobilizing communities to respond to the AIDS epidemic in Malawi.



Salima Peer Educators!

Hope Kit Activity

Before the training, it was observed that YFHS were under-utilized by youth in Salima district because trained health personnel were either transferred to other health centres or too busy to properly allocate time and commitment to YFHS activities.  In training 34 youths in peer education and the Hope Kit, young leaders will be able to continue YFHS meetings and facilitate discussions amongst peers regarding health, education, and goal setting.  YFHS service providers attending the training gained refresher skills and acquired the Hope Kit as a tool to educate not only youths that attend YFHS, but also community members that seek services and health education.

The Hope Kit approach was initiated by the Malawi BRIDGE project in order to reduce the incidence of HIV/AIDS in Malawi through multilevel efforts that seek to change people’s behaviors, attitudes and perceptions regarding the transmission of HIV/ and AIDS.  The Journey of Hope is a set of practical experiential learning activities designed to address a range of HIV/AIDS related issues in particular HIV prevention. It guides participants to develop life skills that can help them deal with different situations, linked to staying healthy and achieving their goals and dreams in life.  The Journey of Hope provides one of strategies that call for all Malawians to be empowered to choose positively when making decisions. These choices are based on practical experiences that young people as well as adults face in real life situations.

Nditha! (Yes, I can!)

Objectives:

1.    To equip the participants with Peer education techniques and methodologies, knowledge and skills, which they will be using in disseminating sexual reproductive health and HIV/AIDS messages to their peers in the communities.

2.    To promote ABC prevention methods among youth and young people in the surrounding communities. 

      Follow up

Each youth developed a three month workplan to facilitate peer education sessions in their communities.  I am following up with each youth, observing teaching sessions, and providing feedback.  So far, the youth are enthusiastic about peer education.  

Me swimming in a sea of Hope Kits!

What I'm Doing Here, Part I

Mkuta Mwana (Surround the Child)

FHI is working in partnership with government entities, health facilities, CBOs and local NGOs to provide comprehensive care and support services for 18,000 vulnerable children and families (VCF) affected by HIV/AIDS in Salima by 2013.  These services include health, education, social welfare and livelihood services, and interventions aimed at ensuring children’s’ successful transition to adulthood.  The Mkuta Mwana program works within the district development framework to strengthen existing community systems and services, while also providing tailored services through a select team of CBOs reaching children and their families through community volunteers, CBCCs, primary schools, and health centers as entry points.  Currently, the program has reached over 12,000 VCF.  The program works with district government structures, 17 health facilities, 13 CBOs, one collaborating partner, 3 local NGOs, 10 TAs, and 44 PLHIV support groups.

Specific to health, Mkuta Mwana works with the District Health Office (DHO) to help improve basic infrastructure and train healthcare workers at 17 local health facilities.  Thirty-four health personnel were  trained in Youth Friendly Health Services (YFHS) in early 2010, which provided support to make health centers more youth-friendly, such as the sensitization of staff, the provision of recreational equipment and health information, education, and communication materials. 

Youth Friendly Health Services

Malawian youths (ages 10-24) do not have adequate nor equitable access to sexual and reproductive health  and HIV services. Prevailing health problems facing young people include:  sexually transmitted infections including HIV/AIDS, early pregnancies, malnutrition, alcohol and drug abuse, and mental health problems.  To address this health disparity, the Malawian Ministry of Health adopted Youth Friendly Health Services, defined as:

Youth Friendly Health Services are high quality services that are

relevant, accessible, attractive, affordable, appropriate and

acceptable to the young people. The services are provided in line

with the minimum health package and aims to increase

acceptability and use of health services by young people.

FHI collects monthly service provision forms from each of the health centers located in the Salima District Health Office.  Reporting has been untimely and not all health centers turn in reports.  Reports include service profiles on youths ages 10 to 24 with services including family planning information and services, condom promotion and provision, sexually transmitted infections (STI) management, HIV/AIDS Testing and Counseling (HTC), prevention of mother-to-child transmission (PMTCT), anti-retroviral treatment (ART), post-exposure prophylaxis (PEP), peer education, ante-natal care (ANC), maternal health delivery, post natal care, post abortion care, and other health services.  

In a three month period between November 1, 2010 and January 31, 2011, 11,362 youths sought out YFHS at Salima District Health Centers.   One third of these services were categorized as Other, including malaria, nutrition, prevention of substance use, psychosocial support, injury, management of sexual abuse, etc.  More than 12% of YFHS visits were for HTC, an average of 457 HTC visits per month by youths.  However, an average of 87 youth males received HTC services per month compared to 370 HTC visits per month by female youths.  Also of importance, more than 12% of YFHS visits were pregnancy related.  Only 10% of visits were for family planning information and services.  It is imperative that more information and guidance be provided to youths in Salima regarding HTC, family planning, and maternal health.

Since November 2010, I have helped monitor YFHS within the Salima District.  Of the 17 health centers, 13 YFHS activity days have been observed.  At these activity days, youth congregate at local health centers to participate in recreational activities such as soccer, volleyball, cards, and bawo (local Malawian game).  In addition to participating in physical activities, youth also listen to health talks from trained health personnel on topics such as HIV testing, family planning, and condoms. While I visit the youths, I chat with them about their health needs and perceptions.  Currently, our conversations are limited due to my lack of Chichewa fluency.  I also recently procured updated health education posters, charts, and stickers for health centers to post throughout their facilities.   

I will continue supervising this activity along with the District YFHS Coordinator for the next 1.5 years of my service as a Peace Corps Volunteer.  Plans for the YFHS program include training of 34 youth (half girls, half boys) and 17 additional health service providers to become peer educators in their communities.  Youths and health personnel will be provided with Hope Kits, a prevention tool that provides and emphasizes activities and actions that individuals or groups of people can take as steps towards HIV prevention or mobilizing communities to respond to the HIV/AIDS epidemic in Malawi.