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 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 2 nd child Baseline Endline n n n n n n n n PRACHAR Project % %

Sl.Research questionsIntervention model AWhat happens to behavioural outcomes if comprehensive intervention continues for 2 more yrs? 1. Comprehensive 5 years BWhat is the effect of discontinuing comprehensive intervention? Will change be sustained for two years? 2. Discontinued comprehensive CCan trained volunteers affect/ sustain behaviour change as effectively as paid NGO staff? 3. Discontinued comprehensive but trained volunteers added DWill shorter duration of comprehensive intervention have the same impact on behavioural outcomes? 4. Comprehensive intervention new areas only 2 years EWhat 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 ● 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

QuestionModel Parity ZeroOne 1 Comprehensive continued for 2 more years (Compr. 5) Use stabilizesUse 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 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 VisitUse increasesNo increase Training 2Use increasesNo increase Volunteers 2Use increasesNo increase Comprehensive 2-yr.Use increasesNo increase Home visit vs. Compr. 2 Home visit vs. Training 2 Home visit vs. Volunteers 2 Home visit > Compr. 2 Home visit > Training 2 Home 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 Project ** p<0.01

* * * PRACHAR Project Adjusted odds ratios for effect of intervention exposure to the number 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 trained during March, September, 2004 Follow-up study conducted 5 years later: October, 2008 – November, 2008 ADOLESCENT 5 YEAR FOLLOW UP STUDY PRACHAR 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: during the survey Longitudinal 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 Project

PHASE III Government alone have limited ability to reach women and men of ‘0’& ‘1’ parity and unmarried adolescents aged 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 Project

Thank you