Results

If the Fund's various adolescent reproductive health initiatives are to have a real impact, their quality must be ensured. Activities must be evaluated to see if they have worked, and reasons must be determined for their success or failure. Also, effective programmes should be expanded and duplicated, where appropriate, to reach more young people. 

In Uganda, the innovative peer-counselling programme known as PEARL has been carried out now for several years and has been judged a success by the Government and many outside observers. While the programme's overall impact is difficult to measure, preliminary results from a survey in two districts highlight some interesting results. In Mubende district, where PEARL has been in operation since 1995, knowledge and use of contraception is more widespread than in Kibale, where the programme started two years later in 1997. The survey showed that by the age of 19, 58 per cent of Kibale girls had been pregnant, while only 6 per cent of Mubende girls had been. This is attributed to the much higher use of condoms in Mubende: 67 per cent of Mubende girls reported using a condom, while only 11 per cent of Kibale girls did. 

In Vanuatu, a youth theatre group called Wan Smolbag has performed at least 30 youth-oriented plays, in English and the national language, over the past few years on various reproductive health subjects, including the transmission of STDs. Tracking studies show that the number of young people visiting health clinics increases every time Wan Smolbag mounts one of its productions in a community. Due to this finding, UNFPA has decided to fund a project to make Wan Smolbag's play and radio scripts available to others who are interested in promoting reproductive health. 

In the Philippines, where several innovative approaches have been tested under an adolescent health project, peer counselling has shown the most promise. The Counselling-on-the-Air project enabled youth counsellors to reach out to other youth, as well as to parents and teachers, through a radio programme that gave young people the opportunity to share their views with other youth and adults. An evaluation of the programme noted that there was a "tendency among some of the youth volunteers to see themselves as different from their peers, particularly those who had the 'misfortune' of being young and pregnant". Obviously, the continued viability of such programmes requires that such attitudes be addressed. 

UNFPA's Office of Oversight and Evaluation undertakes evaluations of projects on a regular basis. In 1999, the Fund published an evaluation report, Implementing the Reproductive Health Vision: Progress and New Directions for UNFPA, which included an important section on adolescent reproductive health. The report noted the need to carefully define target groups (married adolescents, for example, usually can and do receive services through the regular health system); to reach out to overlooked groups such as rural youth; to improve cooperation with NGOs; and to make use of non-clinical approaches. 

In 1999 UNFPA initiated an innovative initiative to complement formal programme evaluation efforts. Case studies are now posted on the Fund's Internet bulletin board site, allowing staff quick reference to best practices and lessons learned. In the case of adolescent reproductive health, the studies are indexed according to 11 sub-categories. One of the cases in the database shows the successful role that youth clubs have played in Bangladesh, especially when they were democratic and gender balanced. A peer education project in Haiti was shown to be very successful but in need of ways to keep the peer educators motivated. 

A project in Jamaica, which delivered a minimum package of reproductive health services to young people in a marginal urban area, was identified as a laboratory that could help build national consensus on the content and direction of adolescent reproductive health policies and programmes throughout the country. A capacity-building project in Namibia carried out several successful initiatives but was challenged by the need to develop consistent referral systems. A review of the work of four youth centres supported by UNFPA in Senegal found that adolescents were more at ease with persons of their own age when getting information about general reproductive health issues but preferred contact with adult professionals when a specific reproductive health question needed to be solved. 

Once a successful programme has been devised, tested and adjusted accordingly, it is necessary to up-scale its activities so that all potential clients can benefit. In Burkina Faso, for example, the Fund has worked for a number of years to introduce population education into the curricula of primary schools and some secondary schools. Based on these experiences, UNFPA supported efforts in 1999 to introduce population education into all of the country's secondary schools. 

If adolescent reproductive health programmes are to be successful over time and reach young people, they must enjoy real support from governments, non-governmental organizations and other partners. In Cairo and New York, governments pledged their commitment to reproductive health information and services for young people. Now we must work together and intensify efforts to turn that commitment into action. 

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