Nepal: HIV/AIDS and Reproductive Health Programme: Final Evaluation

Background

This evaluation study was carried out for Nepal Red Cross Society who has been implementing Adolescent Reproductive Health and HIV/AIDS Programme in seven districts in Nepal with financial and technical assistance from Norwegian Red Cross. The programme was implemented from 2000 to 2004. A baseline study was also carried out in 2000 to establish benchmarks and gather information to design a specific approach to address the situation of youth and adolescents.

Purpose/objective

The objectives of the evaluation were as follows:
• A general assessment of projects achievements in terms of capacity building at local communities, reduction of vulnerability around HIV/AIDS among target groups, effectiveness (including Cost-effectiveness), sustainability and advocacy.
• A general assessment of capacity building at the district chapter, sub chapter level of NRCS and the community
• An assessment of the degree of coordination and collaboration with relevant agency of the government, NGOs and NGOs.

Methodology

Both qualitative and quantitative methodologies were used in the study, as specified in the Terms of Reference (TOR). For the primary information, basically, participatory tools were applied. In particular, focus group discussion and interaction with respondents and key informants (like peer educators, health service providers, school headmasters, parents, teacher sponsors, Red Cross representatives, and opinion leaders) and in-depth interviews were used. Documents review and observations/visits at schools and local communities were also among the methods used.

Quantitative methodology was used primarily to assess the knowledge, attitude and behaviour of school-attending adolescents in the age bracket of 13 - 19 from class eight to ten. Quantitative data thus collected were entered and analysed using Statistical Program for Social Scientists (SPSS). Qualitative data were collected to assess the effectiveness of the programme, capacities, benefits and management issues, from wide range of people (students, local leaders, government officials, donor agencies).

Key findings

The HIV/AIDS and adolescent reproductive health programme is primarily targeted at school youth. The programme was implemented in collaboration with schools, using a Peer Education approach. Red Cross District Chapters were responsible for day to day management of the programme for which a full time Field Coordinator was assigned. Red Cross Head Quarters (HQ) provides continuous support, guidance, coordination and other input for the programme implementation.

Qualitative and quantitative data indicated that the overall knowledge and attitude related to HIV/AIDS and reproductive health is very good both among the Peer Educators and other students, with some exceptions. Many can express correctly the route of HIV transmission as well as ways to prevent the transmission. Teacher Sponsors (teacher responsible for Junior Red Cross activity in the school), Peer Educators, radio and magazines are the main sources of information for many young people. Knowledge on reproductive health is also high, and a majority of youth are confident of their ability to manage physical and emotional changes occurring during the adolescent period.

Similarly, in all programme districts, women's groups are either purposely formed around HIV/AIDS education or HIV/AIDS activities were integrated to existing women's group. Among the women's groups the level of knowledge, confidence and activities varied a lot. In Gulmi a group was formed only of Dalit women for conducting HIV/AIDS activities and training. If only one particular group is targeted for HIV/AIDS activities, there is a danger in creating a stigma for that particular group.

Gender balance was maintained while selecting Peer Educators, but a majority of Teacher Sponsors are male. Many teachers see no difference in teaching female or male students despite the realisation that there are more social restrictions for girls than for boys. The Red Cross organisation as a whole is male dominated and stakeholders have mixed views about it. More coordination and linkage is suggested for better programme implementation.

The Red Cross has comparative advantage in implementing activities in the field in the current political context. In the current programme districts, Red Cross has no problem in conducting field activities. Youth and teachers also feel safe being associated with the Red Cross. In addition to this, since the programme is implemented through existing structures i.e. schools and teachers, no additional cost is required to set up and maintain the structure.

Recommendations

Definition and application of the Peer Education approach needs to be redefined, making the process more interactive and continuous. This is a good opportunity for the Red Cross to establish a firm working modality on Peer Education for school youth and community youth.

Gender equity and equality within the wider context of NRCS institutions at policy and other levels is a major concern. The problem must be given serious consideration, enabling more female members to join the executive committee at the central and district levels. More specifically, there is a need for sensitisation workshops among district chapter members, teacher sponsors, peer educators and their target group, on gender equity and what it means in practice.

In the current situation, the Government is developing a school curriculum in order to integrate life skills and reproductive health in an extensive way in the schools. NRCS has been in the forefront of the in-school approach, and should be proactive in planning changes to their programme. If the programme in the schools will be taken care of by the teachers directly through the government support in the future, NRCS might want to look at ways for reaching the out-of-school youths, those who drop out, or other vulnerable groups.

Comments from the organisation

The Norwegian Red Cross accepts the conclusions of the evaluation and had taken measures to follow-up the findings and recommendations. A review of the project in general and the target group had already taken place. The project target group will from 2005 include out of school youth and a pilot project for combating trafficking will start in one district.