PRESENTED AT

RECONVENING BANGKOK: 2007 TO 2010-PROGRESS MADE

AND

LESSIONS LEARNED IN SCALING UP FP-MNCH BEST

PRACTICES

IN THE ASIA AND THE MIDDLE EAST (AME) REGION

6 - 11 MARCH 2010

“EVIDENCE BASED ADVOCACY AND SCALE – UP

YOUTH REPRODUCTIVE HEALTH COMMUNICATION

INTERVENTION-PRACHAR MODEL,

BIHAR, INDIA”

PRESENTED BY: DR. E.E. DANIEL

PROJECT CHARACTERISTICS

Community based

Multi disciplinary youth focused RH/FP communication intervention

Use of interpersonal communication methods

Use of multiple methods & media for behaviour change communication

Strong, built in monitoring, supervision, MIS & surveillance

Rigorous evaluation

Use of scientific, epidemiological approach

Current use of contraceptives in Phase I

Use of contraceptive to delay 1st child

Use of contraceptive to space 2nd child

Baseline Endline

n n600 624

n n1389 1455

n n604 612

n n1381 1452

PRACHAR ProjectPRACHAR Project

%%

Sl. Research questions Intervention model

A What happens to behavioural outcomes if comprehensive intervention continues for 2 more yrs?

1. Comprehensive 5 years

B What is the effect of discontinuing comprehensive intervention? Will change be sustained for two years?

2. Discontinued comprehensive

C Can trained volunteers affect/ sustain behaviour change as effectively as paid NGO staff?

3. Discontinued comprehensive but trained volunteers added

D Will shorter duration of comprehensive intervention have the same impact on behavioural outcomes?

4. Comprehensive intervention new areas only 2 years

E What relative impact will selected strands of comprehensive intervention have on behavioural outcomes?

a. Home visits

b. Training

c. Volunteers

5. New areas only Home visits 2 yrs 6. New areas only Training 2 yrs.

7. New areas only volunteers 2yrs.

RESEARCH QUESTIONS SET IN PHASE II

Evaluation Survey Design

Evaluation Survey Design

● Quazi-experimental program trial ( intervention- comparison and baseline –

endline survey) design

● 20x15 Cluster Sampling Method

● Population stratified, two stage, systematic, probability proportional to size (PPS)

● Recommended by Institute for Research in Medical Statistics (IRMS)

● Total sample size; intervention models – 23400, comparison area - 3900

Question Model Parity

Zero One

1 Comprehensive continued for 2 more years (Compr. 5)

Use stabilizes Use continues to increase

2 Comprehensive discontinued Initial decline but stabilizes afterward

Initially declines but stabilizes afterward

3 Discontinued and Volunteers added

Same as discontinued model

Same as discontinued model

4 Two years vs. three years of comprehensive interventions

Use increases in 3-yr. Use increases in 2-yr. 3-yr > 2-yr.

Use increases in 3-yr. Use increases in 2-yr. 3-yr > 2-yr.

5

Home Visit Use increases No increaseTraining 2 Use increases No increaseVolunteers 2 Use increases No increaseComprehensive 2-yr. Use increases No increase

Home visit vs. Compr. 2Home visit vs. Training 2Home visit vs. Volunteers 2

Home visit > Compr. 2Home visit > Training 2Home visit > Volunteers 2

No difference

Summary findings: effect on contraceptive use

Adjusted odds ratios for effect of intervention exposure of wife /husband/ both on

use of contraceptives

* *

PRACHAR ProjectPRACHAR Project

** p<0.01

* * *

PRACHAR ProjectPRACHAR ProjectAdjusted odds ratios for effect of intervention exposure

to thenumber of intervention activities

** *p<0.01

Objective

To examine the effect of interventions on: Age at marriage,

Contraceptive use

Delaying and spacing of

births

Background• Unmarried girls and boys aged 15-19 trained during March, 2003 -

September, 2004• Follow-up study conducted 5 years later: October, 2008 –

November, 2008

ADOLESCENT 5 YEAR FOLLOW UP STUDY

PRACHAR ProjectPRACHAR Project

Methodology• 300 girls & 300 boys were randomly selected from the list of trained

girls and boys• Equal number of girls and boys were randomly selected from the

comparison area• Age: 19-24 during the surveyLongitudinal data analysis• Transition: unmarried to married, to having children & timing of

contraceptive use• Life table • Proportional hazards regression

EVIDENCE FROM PRACHAR Environment building activities with parents and community elders are essential

for obtaining programmatic access to adolescents and young couples.

Behaviour change was greatest among couples reached as unmarried adolescents (through trainings) demonstrating that inputs provided in adolescence strongly influence contraceptive and RH behaviour after marriage

Young men lead the change in reproductive behaviour . Even if women were not reached, significant change was achieved by reaching men and behaviour change was greatest when both men & women were reached

Continued home visits to women to reinforce messages are imperative. Behaviour change was greatest among couples reached early after marriage/ childbirth

Behaviour change was greater among couples reached with more than one intervention strategy , reached at more than one life cycle stage and when women participated in decision making on use of contraception

PRACHAR ProjectPRACHAR Project

PHASE III

Government alone have limited ability to reach women and men of ‘0’& ‘1’ parity and unmarried adolescents aged 15-19

New delivery system is needed to deliver programmatic inputs and provide overall management, supervision and technical support to ensure coverage, quality, outputs and outcomes

Pathfinder will: work to forge and test an innovative hybrid Government – NGO partnership capable of jointly delivering a youth reproductive behaviour change intervention at scale

Joint coordinated program implementation by Government and NGO will facilitate acceptance of Prachar approaches, ensure Government ownership of the scale up process and help promote sustainability as well as scalability to other districts state and countries

PRACHAR ProjectPRACHAR Project

Thank you