Fekadu
Small Project Proposal
Title:
Youth Centers in Ethiopia: An Assessment of the Family Guidance Association of
Ethiopia’s (FGAE’s) Program.
Background and Problem to be addressed:
In Ethiopia, the sexual and reproductive health of young people has become a
major public concern, particularly with the advent of AIDS. There is a growing
awareness and concern about the very high rates of unwanted pregnancy, unsafe abortion,
and STD/HIV infection among young people (WHO, 1999).
The Ethiopian youth population, defined as the population between the ages of 10
and 24, is estimated to be 32% of the total population (Policy, 2000). The relatively large
size of this cohort in the total population is important because its behavior not only
affects the demographic future of the country, but also influences future behavior as these
young adults mature in age. Hence, programs aimed at providing information, ensure
access to services, and develop life skills are crucial to the future of this population
segment (Moreland R. et al. 2001).
Despite all the efforts to address the reproductive health needs of young people in
Ethiopia, the National Reproductive Health Needs Assessment showed that there are a lot
of gaps in youth friendly reproductive health services (WHO, 1999). One classical
finding was that young people are well aware of family planning methods. However, the
utilization of family planning services in the existing health care system by young people
was very low and a high rate of unwanted pregnancy and abortion complications were
demonstrated. Complications due to unsafe abortion are a major cause of maternal
mortality in urban centers. The majority, 67.2%, of those seeking treatment for
incomplete abortion are under 24 years old (WHO, 1999). In a survey, among adolescents
in six urban centers in which 18% of the girls reported unintended/unwanted pregnancy,
39% resulted in abortion (OSSA, 1999)
Another major health threat affecting young people are reproductive tract
infections, including HIV/AIDS. National statistics provide indication of the scope and
1
magnitude of this major public health problem. Current estimates indicate that in the year
2000, just over one quarter (26%) of the HIV positive population in Ethiopia was
between the ages of 10 and 24. By the year 2010, the total HIV positive population is
projected to grow by over one million overall (from the present 2.4 million) and by nearly
300,000 in the 10 – 24 age group. The nation’s young people run a disproportionately
high risk of not only contracting STD/HIV/AIDS, but of being excluded from appropriate
curative and preventive services and information (Policy, 2000).
The Family Guidance Association of Ethiopia (FGAE), which is a pioneer of
youth programs in Ethiopia, started its services in early 80’s with the provision of Family
Life Education (Taffa N. et al, 1999). It established its first youth center in Addis Ababa
in 1990, with the objective of providing youth friendly reproductive health services and
replicated it in a more wider geographical coverage since 1992. Currently, it runs 17
Youth Centers throughout the country, and it is still the only organization that is
providing adolescent reproductive health services through this model. However, while
FGAE has invested a great deal in the youth center model, there are little empirical bases
from evaluation, and practically none is available for youth program components. Thus,
there are many questions which remained unanswered. These include: who uses the
Youth Centers and why? What are the levels and patterns of patronage of the Youth
Centers? What are the unanswered concerns of the youth? Are the personnel and peer
promoters at the centers well equipped and trained for the role they are expected to play?
What are the suggestions for improving the centers? What are the costs of services and
the implications for sustainability? In the absence of such sound program evaluation, it is
unclear where future efforts should be directed and which programs or program
components should be replicated. Thus, a systematic assessment of these centers would
be critical.
Objectives of the Study:
The main objective of this study is to assess the overall performance and
effectiveness of FGAE’s youth centers and determine the quality and appropriateness of
existing services.
2
Specifically, the study is designed to achieve the following objectives:
1. To determine the levels and patterns of utilization of the Youth Centers;
2. To determine the levels of availability, accessibility and affordability of
the Youth Center services;
3. to assess the level of awareness, knowledge and attitude of youth
regarding their sexuality and available services;
4. To identify the key challenges and obstacles that prevent youth from using
services.
Research Design and Methodology
Although the youth centers’ target population includes all adolescents and young
people aged 10 – 24, this study will focus on those between the ages of 15 and 24. The
study will use a variety of data sources including an inventory of youth center services;
interviews with service providers and youth center clients; analysis of service statistics as
well as community based survey in the areas surrounding the youth centers.
Study Population
The study will be conducted at three sites (Bahirdar, Jima and Wolliso). These
areas have been selected because of convenience and accessibility for the study and the
possibility of getting a good mixture of suburban and urban population.
The study subjects are:

Out of school youth: including street youth, petty traders, daily laborers, shoe
shiners, school withdrawals etc.(age 15 – 24);

In school youth: high school students (age15 – 24);

Service providers (staff and peer service providers)
Data will be collected through Situation analysis of the youth centers and community
based survey of the catchment areas of the centers
3
Situation Analysis of the centers:
The situation analysis of the youth centers focuses on the analyses of relationships
between subsystem functioning and the quality of services provided and received.
Information will be collected through observation and interview techniques from service
providers and youth center clients on a few key indicators of each youth reproductive
health service subsystems. The subsystems are: supplies; facilities; staffing; training;
supervision; information, education and communication (IEC); counseling and; services.
The indicators of these subsystems provide information which helps answer the following
three questions:
1. Is each subsystem in place, that is, potentially ready to provide services?
2. If in place, is each subsystem functioning, that is, providing some level
(quantity) of services to clients?
3. If functioning, is each subsystem providing quality services in terms of
choice, provider-client interaction and provider competence etc.
Each center will be visited for three days, during which time interviews with staff and
clients and attendance data will be collected. Every client that comes to the youth center
for any reason during the three days will be interviewed.
The interviews with all professional staff and youth service providers will be self
administered questionnaires seeking to measure staff/ peer service providers’ views of the
youth center; their knowledge of reproductive health; attitudes toward adolescent
sexuality and services; as well as their counseling abilities. Questionnaires with youth
center clients will be interviewer administered. Clients’ access to the centers; their pattern
of utilization; and their views of the service providers will be assessed. In addition, client
reproductive health knowledge and attitude will be measured. Research assistants will
record client’s movement at the youth centers during opening hours over the three
consecutive days. Information to be collected includes sex, age, school status, and school
level of visitor, service received, and the time of the visit. Retrospective service statistics,
facilities and equipment, information on hours and days of operation, staffing structure,
and services offered will be reviewed.
4
Community Based Survey of the Catchment Areas of the Centers
This is a cross sectional survey with in-school and out-of-school youth. Structured and
non-structured questionnaires will be used to assess different areas of youth reproductive
health services. The quantitative study will be conducted through self administered
questionnaire. It covers areas including general socio-demographic particulars of the
respondents and issues that are related to the youth center services. The survey will be
undertaken in the catchment areas of up to three kilometers from each center.
Sampling Technique
Initial selection of subjects will be made through stratified sampling technique
and later random or systematic samples of a predetermined size will be taken by
proportion from each group. Selection of in-school youth will be done with equal
proportion of study subjects from each grade. Equal sample size will be taken from
grades 9, 10, 11 and 12. One section from each grade will be selected with due
consideration to male – female proportion. Male – female proportions will be calculated
from list of students.
Finally each study unit will be selected through a simple random sampling, while
selection of out-of-school youth will be carried out through convenience sampling. The
type of convenience sample to be employed in this study will be snow ball sampling
technique. A meeting will be called through peer service providers to be held at
convenient places. The invitation for the meeting will include all out-of-school youth
residing in the catchment area of the centers within 3 kilo meters radius. Then, the
purpose of the meeting and objective of the study will be explained to them. Those
individuals who are willing to be interviewed would become a snow ball sample and they
will be asked to recommend acquaintance (recruit other out-of-school youth) for the
study.
5
Sample Size
According to available data the youth population between the age of 15 and 24 (the target
of this study) is estimated to be 22% of the total population. Therefore the total eligible
population in the three study areas (towns) will be 54,000.
Studies on youth sexuality among high school students suggested that total male student
in high school are 55% while the rest 45% are females. In addition, 82.8% of students are
between 15 – 18 years of age (Gebresenbet, S. et al 1998). They also estimate that 46% of
youth are out of school.
This study attempts to make comparative analysis between in-school and out-of-school
youth. The fundamental questions are level of utilization rate; accessibility of services;
awareness/knowledge/attitude and; barriers to services. Assuming 95% confidence level,
the sample size for both groups was calculated using stat calc for each study question as
follows.
Study question
In-school
Out-of-school
Total
sample sample size
%
Sample
%
Level of utilization rate
30
179
50
149
328
% Accessible to youth centers
45
185
65
154
339
Level of awareness/knowledge
85
233
70
194
427
Obstacles/barriers
80
76
50
63
139
Based on this, a total sample size of 427 will be required to get significant result. Sample
size for each town will be allocated based on population size in each town.
A qualitative study will also be conducted through focus group discussion with
youth and in-depth interview with service providers to get information about questions
that remain unanswered or are not addressed in the quantitative study. Study subjects
enrolled in focus group discussion will be youth from schools and out-of- schools. Each
group will consist of 6 - 8 participants. A total of 4 youth focus group discussions will be
conducted in each town i.e. out of school youth (male and female), in-school youth (male
6
and female). Generally a minimum of 32 people will be recruited and participated in the
youth focus group discussion in each town. A total of 3 x 32 = 96 individuals will be
involved. The participants will be selected through convenience sampling to get a total
number of 8 people in each FGD.
Questionnaire Development
Existing standard questionnaires will be adapted to suit the purpose of this study. By
reviewing and examining different standard questionnaires, questions will be developed
based on common guiding principles. In this study the following guiding topics will be
used for formulation of questions:

Acceptability

Accessibility

Affordability

Quality

Attitudes of youth towards the youth centers

Technical competence of service providers

Knowledge, attitude and practice of youth

Challenges and obstacles (social, economic, institutional barriers)
Pre-testing
The questionnaires and all other data collection instruments will be pilot tested
with the participation and feedback of program managers, key personnel and youth to
ensure validity and reliability. Each enumerator will interview 5 respondents, after the
training, to check the appropriateness of the questionnaires and their capability.
Data collection
During data collection, the purpose and objective of the study will be sufficiently
explained to the informants. The data collection will be confidential and anonymous.
Consent will also be obtained from respondents.
7
A three days training will be given to the interviewers and their supervisors on the
study methodology and how to administer the questionnaires.
The questionnaire for students and out-of-school youth who are grade 9 and above
will be self administered. For students, it will take place in schools, in a separate class
after selection of study units. For service providers it will be administered in their work
place; and for out of school youth it will be at any place which is convenient for data
collection.
Data Analysis
The Data will be analyzed using Epi-info 2002 statistical package. The findings of
the study will be presented in proportion, frequencies percentage frequencies in 2 x 2 or 2
x 3 contingency tables for convenience of comparing results. Analysis will also be made
by using measures of central tendencies: mean median and standard deviations. Data
obtained from this study will be presented in cross tabulations and descriptive approach.
The findings will be tested using the chi-square for examining differences among
variables. Thus, from the findings, it is possible to highlight areas of challenges and
obstacles in service delivery for youth in relation to SRH which will in turn lead to some
conclusions and recommendations in designing future strategies and interventions.
Independent variables, which includes age, sex, religion, educational status,
marital status, occupation, school status, residence, awareness/knowledge and; dependent
variables which includes service utilization and risk behavior will be employed in the
analysis.
The actual analysis of the qualitative data will be made with a search for themes, i.e.
textual analysis will be employed.
Ethical Consideration
To get ethical acceptance, all concerned bodies at all levels will be informed of
the aims and objectives as well as expected advantages of the study. Ethical permission
will be obtained from Science and Technology Commission. Consent will also be
requested from youth and service providers before queries are presented to them.
8
Dissemination
A half day dissemination workshop will be organized at two levels (one in-house
with staff and management and the other one with all stake holders including donors) to
discuss the findings of the study and agree upon future directions. The comments and
opinions gathered during the workshops will be considered in the revision of FGAE’s
strategic plan. Copies of the study report will be sent to the Ministry of Health, other
stakeholders and the funding agency.
Inputs
The required inputs for this study will include: 15 interviewers (5/town), 3
supervisors, research assistant, principal investigator and stationery. The research and
evaluation officer of FGAE will be involved in the whole process of the study as research
assistant. A total of US$ 3980 is needed to conduct this study. Specification of personnel
and other material inputs are shown in the detail budget section.
Activities
The activities of this study will be conducted in four phases. In the first phase
activities related to questionnaire preparation; recruitment and training of interviewers;
pretest; sample identification and preparation of the study population will be carried out.
In phase two actual data collection will be conducted. Activities related to data entry,
cleaning and analysis will take place in the third phase. In the fourth phase, write up and
communication activities will be accomplished.
Output and Impact of the Study
The findings and recommendations from this research, as an output, will be useful
not only to FGAE’s youth program, but are also relevant for other governmental and nongovernmental agencies that are intending to use this model. The lessons learned from the
research will equally be useful for policy makers and government officials whose work
entails ensuring the welfare of youth. Other outputs include enhanced research capacity, a
model for program evaluation, and experience in use of evaluation data for program
management and strengthening.
9
Leadership Skills
One important way to accomplish the intended objectives of this study is to
involve not only researchers but also program managers, staff and youth in the entire
process. This involvement links the experiences of managers and service providers with
the problems and understanding of the utilization and effectiveness of the youth program.
Teaming researchers, program managers and service providers is an educational
experience for everyone. This will have long-range benefit that go far beyond the
implementation of the study.
Self awareness which refers to the understanding of issues involving ethics, power and
values of people is required to guide this research project to success. Furthermore,
listening and communication skills has important place in this study process. That is,
there is a need to clearly communicate the purpose of and benefit of the study to all
concerned. Listening, willingness to accept ideas and suggestions from colleagues and
others will be crucial in the preparation of data collection instruments and data collection
process.
Chronology
Activity
Questionnaire preparation
Recruitment of interviewers
Training of interviewers
Pretest
Sample identification and preparation
Data collection
Data entry, cleaning and analysis
Write-up
Dissemination of results
Submission of reports
Revisiting FGAE’s existing strategic plan
1
X
2
Month
3
4
5
6
X
X
X
X
X
X
X
X
X
X
X
X
X
10
Budget (USD)
Quantity Duration Unit cost
Item
Total cost
of work
Personnel:
Principal investigator
1
6 month
140/month 840
Research assistant
1
6 month
70/month
420
Supervisors
3
4 weeks
30/week
120
Interviewers (5/site x 3 sites)
15
4 weeks
15/week
900
Driver
1
4 weeks
15/week
60
US based staff (technical assistant)
1
1 week
--------
---
Sub total
2340
Transport cost:
Fuel
800 lit
4 weeks
Vehicle maintenance
0.50/litter
400
200
200
Sub total
600
Miscellaneous:
Stationery
60 rim
4
240
Telephone/fax/postage
200
200
Secretarial service
200
200
Sub total
-
640
Dissemination workshop (1/2 day each)
FGAE staff/management (snacks/drinks)
200
Stakeholders (snacks and drinks)
200
Sub total
Total project cost
400
3980
11
References
1. Gebresenbet S. et al. (1998). Knowledge, Attitude and Practice on HIV/AIDS
among high school students in SNNPR. Awassa, Ethiopia.
2. Moreland R. et al. (2001). Ethiopian Youth: Reproductive Health in Profile,
Washington, D.C, USA.
3. OSSA (1999). KAP of Adolescents on Sexual Reproductive Health. Adolescent
Reproductive Health Initiative (ARHI) Project, Organization for Social Services
for AIDS and German Foundation for World Population. Addis Ababa, Ethiopia.
4. Policy Project (2000). Data Files of the AIM Model, Addis Ababa, Ethiopia.
5. Taffa N. et al. (1999). Do parents and young people communicate on sexual
maters? The situation of family life education in a rural town in Ethiopia.
Ethiopian Journal of Health Development 10: 35-39.
6. World Health Organization (WHO) 1999. Expanding Options in Reproductive
Health: An Assessment of Reproductive Health Needs in Ethiopia. Geneva,
Switzerland.
12