Reflection on Learning from the Knowledge Sharing Projects
Final Program Report
I.
Introduction
“…a real man is that who has more girlfriends, who has
several sexual relations…”
“the most macho is whoever gets a woman pregnant…”
Young adolescents of Ascención District School – Huancavelica,
Perú – AHMAR’s Self-diagnosis Study, June 2008
In June 2008, CARE USA’s Sexual and Reproductive Health Team launched a second
KS fund to support staff experimenting with documenting and sharing their
experiences with Social Analysis and Action (SAA) for family planning. The objectives
of the KS projects were:
1. Integration of SAA into an existing Country Office project to address the complex
social and cultural barriers that impact use of family planning.
2. Strengthen CO capacity in FP and SRH program implementation.
3. Develop SAA Champions to share knowledge and experience in integrating SAA
for improved family planning with colleagues and partners
CARE Peru selected AHMAR (Adolescents of Huancavelica for a Responsible
Masculinity) Project as the enabling project environment to work the learning on how
addressing social factors could avoid limits and opposition to the understanding,
demand and access to family planning methods. Young men and women behaviours
reflect extended practices and beliefs of Huancavelica’s Andean society itself,
strengthening a vision of women’s inferiority, preventing their recognition as individuals
with the right to decide over their body, their health and their sexual life.
AHMAR Project’s objective is “to contribute with improved attitudes and behaviors of
the adolescents within Huancavelica Region, related to the development of a more
responsibe masculinity”. It combines both a) direct sensitization strategies oriented to
young men and women, promoting peer interaction, with b) communicational
strategies through adolescents themselves and c) strengthening the responsiveness
of health and education services oriented to work with adolescents. This pilot project
looks to fill an important gap within sexual and reproductive health interventions,
mostly focused on women access to information or women empowerment, promoting
peer interaction amongst young men & young women and an information /
communicational program to sensitize target audiences.
AHAMAR constituted a natural “enabling environment” for the KSI on Family Planning
and SAA. The KSI team looked to construct knowledge on the basis of a) adolescent’s
expressions and self-visions collected by AHMAR’s self-diagnosis study; b) having a
deep, comprehensive knowledge on how sexual and reproductive rights are
understood in this specific context; c) working on adolescents’ values and feelings
(self-esteem, responsibility, respect, tenderness, familiar relations and what does to be
in love with a girl really mean); d) providing appropriate information and building
knowledge on the sexual and reproductive system (organs) and how it functions - as
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many times family planning is rejected under the belief that “children come whenever
God decides they should come” – e) constructing the concept of “responsible
sexuality”, incorporating contraceptive approaches on the basis of what means
unwanted pregnancy (adolescent pregnancies) and consequences; f) working both
with male and female adolescents; g) working with local public school officers and
teachers; h) strengthening male and female adolescents leadership with better
consciousness on sexual and reproductive rights; i) using communicational strategies
and reflective practice to evidence and compare which roles are played and their
fairness; j) prioritizing the most available and accessible family planning methods, like
condoms, and k) constructing male adolescents acceptability and girls demand /
consciousness.
II.
Body
a. Results
i.
What is the most significant change that has occurred in your work as a
result of this initiative?
There are changes both in our work and in our own home / lives:
a) Within our work, we could evidence how young men and women built
knowledge on the basis of their own values and feelings (self-esteem,
responsibility, respect, tenderness, familiar relations and what does to be in
love with a girl really mean) and their understanding of sexual and
reproductive health issues, and how they extend this knowledge amongst
their peers. An additional change was the increased interest of school
teachers on a better understanding of masculinities and gender equity
b) Within our team, we have improved and deepen reflective analysis on how
social constructions determine beliefs and behaviors, and how to address
those social constructions. One of the main issues analyzed was how we
also reproduce some attitudes when making jokes or comments amongst
colleagues (like “you are not walking like men do”…). But also on how we
used to believe we knew our adolescent sons and daughters and how now
we realize young men and women understand today their social interaction and which factors influence their attitudes and behavior. This
recognition came with some surprises. Adolescence and adolescents are
not those of our earlier years. Therefore, the Project has promoted a
different, fresh dialogue amongst CARE staff’s adolescents sons and
daughters (Fernanda Loayza, Richard Ccencho and Jorge Gonzales).
c) For Fernanda Loayza, one of our team members, one of the most
significant changes is that “I have learn, as a woman, to better understand
“machista” attitudes (men with little responsibility on their children,
agressive husbands,….)” and increase understanding on how most of
these attitudes have been constructed along years, both within home and
re-enforced in school.
“Sharing with young men and women is great. Once they realize things
could be different, they begin to produce changes, not only in the way they
act within their homes, but also on their own peer relation, and changing
attitudes and demand of family planning methods, especially condoms.
Adolescents like Marco, Edwin. Elvis, Wilson, at the beginning of our work
used to call nicknames to girls, to push them strongly, showing a selfsufficient attitude towards us…now they are different, evidencing a
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respectful behavior with girls, being the most interested in learning and
disseminating messages against violence and promoting self-esteem and
family planning amongst their peers. Even their parents say ‘My Wilson is
different now. He has totally changed, becoming more responsible. Before
he did not care on making any house tasks, he was just waiting for his
mother or sister to do them. He now wants to help me in my work, he has
completely changed. What are you teaching them? Please, continue with
this change’ they say”
Learning developed within the project team and amongst the young men
and women have generated, amongst other changes, social
communication strategies driven by the adolescents themselves.
Campaigns, fairs where the adolescents themselves explain the proper use
of the condom and talk with their peers on the bad consequences of violent
attitudes and behaviors, have proven successful strategies. Also,
adolescents are very conscious of cultural issues and methods of learning
(“learning through playing”, through songs, competitions, etc).
Overall, the self esteem generated amongst the adolescent leaders has
taken them out of alcohol and violence, and they have begun to realize
their role and possibilities of action as social actors, evidenced in their
participation within the Ascención District Committee for the Adolescents.
ii.
How has this initiative influenced your work with your partners (if it has)?
( the community? Government? Others?)
The interest evidenced by the school teachers of América Educational Institute
of Ascensión District, where AHMAR Project takes place, created an
appropriate environment for working with them. That was one of our lessons
learned, in terms that we needed to work also with the teachers, who
frequently constitute on “role models”. But we also needed to work with them
because we were promoting participatory methodologies to build knowledge
amongst the adolescents, but their teachers were not necessarily “participatory
champions”!. It was exactly the opposite: teachers used to treat and teach
adolescents as if they were little children. Addressing traditional vertical,
hierarchical relations from the providers was as important as an entrance to
make them understand adolescents are capable enough to dialogue issues like
family planning and gender equity, issues which were not covered by the
school, though they were part of the School Study Plan. Another important
message shared with the teachers was that change and new knowledge only
begins within themselves, not only with theoretical messages. That is why we
implemented with this KSI a workshop on gender equity, gender-based
violence and masculinities exclusively for the school teachers.
Participated also in the workshop Regional Hospital’s responsible of
Adolescent’s Health. He was very interested in the new knowledge and
experience: “I need to better understand adolescents to improve our work here.
University doesn’t prepare us for this. I remember when Manuela Ramos
(Peruvian NGO) brought us gender approach, we did not know anything about
it. Peruvian Ministry of Health took a while to begin incorporating gender
approaches. Now you are talking about masculinities, something I did not hear
before and is very, very important. We are still behind on this, and surely
Peruvian MoH will just incorporate it within the next five years or so…”.
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iii.
How has the KS initiative influenced your CO programs beyond those of
SRH?
Knowledge built on the basis of how adolescents understand a more
responsible masculinity goes beyond sexual and reproductive health. Gender
violence or even violence amongst male peers could be addressed through
reflective analysis on their masculinities. Diverse inequities placing women in a
lesser level determine malnutrition, lack of education and less autonomous
decision-making. RBA reflected in CARE Programmatic Principles contribute
with a participatory analysis on unjust power relations that lead to these
situations.
On a more general view, methodologies and first lessons learned of AHMAR
Project together with the importance of SAA have been shared with the Health
Program Team, our Expanded Senior Management Team, and have been
visited and shared with CARE’s ACD and National Gender Advisor. Outside of
Peru, lessons learned and especially the methodology of inter-action with
young people has been shared with CARE Bolivia’s Health and Education
Team (21 to 24th, May 2009), who were implementing a pilot project on
masculinities within the Education sector. Learning will also be shared within
the LAC Region´s Gender Program Strategy, currently under development.
Additionally, beyond the explicit inclusion of the learning achieved in the design
and implementation of the Mothers Matter Signature Program, we will also
analyze ways of replicating the SAA Approach through the community
empowerment and health service responsiveness action lines in our health
program.
In a more local approach, CARE Huancavelica Regional Co-ordination
Committee, which monthly gathers the diverse Project team leaders working in
Huancavelica evidenced interest in an internal capacity building process on
gender equity, masculinities, etc.
iv.
How has your work with this initiative changed the way you, personally,
see your work / your life?
As told, working with this initiative has contributed with a fresh dialogue
amongst CARE staff’s adolescent sons and daughters, based on how they
believed adolescents are and how they now realize young men and women
understand their social inter-action.
“In life with my family, the initiative has helped me to better understand my son
and daughter. There is a better communication amongst us; we use to talk on
other young men and women perceptions, on our need to listen and learn from
others…” (Richard Ccencho, AHMAR’s team member).
“In my house, when my child was very young, any time we met a girl of his age
I used to tell him ‘say she is your girlfriend and say mother-in-law to her
mother…he used to do it always and I enjoyed him saying so…I taught him he
could have any woman she could find, but I did not do this with my daughters.
Now I don’t tell my nephews to do something like that, is a different treatment
for men and women…..people also ask me why I do not get angry when my
nephews fall and cry. Before, I used to tell them ‘Boys don’t cry’. Now I explain
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them and my own sons and daughters that I was wrong, that I did not realize
we were strengthening non equal treatment / relations which, at the end of the
day, will also affect women’s rights…” (Fernanda Loayza, AHMAR’s team
member)
b. Process
i.
Provide an outline of the specific steps of implementing this project
a) We began with a team review of CARE’s Social Analysis & Action
approach (Guidelines) together with developing reflective analysis on our
initiative and what we look to achieve on the masculinities issue, on
violence amongst peers, etc. First we use to try the methodologies
amongst us and then with young men and women of the America
Educational Institute. An important tool to know adolescents views and
understanding was the self-diagnosis study. It was very important to build
the proposal on the views and ideas of the young men and women. After
that, the team worked on a series of workshops to analyze adolescents’
values and feelings (self-esteem, responsibility, respect, tenderness,
familiar relations and what does to be in love with a girl really mean); to
provide appropriate information and to build knowledge on the sexual and
reproductive system (organs) and how it functions; to construct the concept
of “responsible sexuality”, incorporating contraceptive approaches on the
basis of what means unwanted pregnancy (adolescent pregnancies) and
consequences; specific workshops with local public school officers and
teachers; building communicational strategies and reflective practice to
evidence and compare which roles are played by men and women and
their fairness; analyzing together with young men the most available and
accessible family planning methods, like condoms; disseminating the new
knowledge and capacities adquired at special “security areas” like the
Young Zone, a special area provided by the Local Government;
Institutional Fairs, school, etc.
One of the last activities that have been recently implemented is a
volunteer system with young men and women, for good practices on SRH,
like how to use a condom, knowledge competition on SRH messages, etc.
An additional activity recently implemented is the production of radio
messages and spots, to better dissemInate this new information and
knowledge.
ii.
How did you use or integrate the SAA approach?
As explained, AHMAR Project was already focusing on an innovative
approach, addressing masculinities amongst Andean society of Huancavelica’s
Ascención district – particularly young men and women - . It was a natural
environment to explore with young men and women the way that social
constructions like masculinities could affect a fair relation with women, but also
amongst themselves. A main issue of incorporating SAA was facilitating
dialogue and analysis amongst the project staff on the self-transformation, that
took place in ourselves through the interaction with young men and women
(somehow an ISOFI way of analyzing our work). Another key issue was the
participatory construction of knowledge, building on the adolescents’ beliefs
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and experiences. We needed to respect young men and women perceptions:
i.e., it was planned to be covered Contraceptive Methods, but talking first with
the adolescents, they told us that most Contraceptive Methods were “for
adults”, they preferred to focus on the appropriate use of condoms. Therefore,
information on preventing adolescents’ pregnancy, preventing STDs, etc, was
brought into discussion around the appropriate use of condoms. It was very
important to build on the adolescents’ views and expectancies. We have also
associated SAA with our current work with RBAs and our Programmatic
Principles. An additional issue is the incorporation of the analysis of social
determinants of SRH into our project proposals, as happened with the Young
men’s Project for European Union and the Mothers Matter Signature Program
of CARE USA.
iii.
How has use of the SAA approach made this project different?
Using SAA for family planning helped us a) to better focus on the existing
relation between them, b) to improve our analysis of actors and social
constructions, related to factors preventing demand and access to
Contraceptive Methods, and c) the respect of young men towards young
women self-decision making. The analysis of “machismo” and gender inequity
with young men and women and the use of the SAA Manual to better design
our intervention with male & female adolescents were important: we have used
tool # 1: Ideal Man / Woman, to analyze beliefs and social constructions
extended amongst the adolescents, gender roles, gender inequities within
home, within society, and to explore beliefs and misconceptions on sex and
family planning. Also tool # 4: Problems trees, to work both with adolescents
and teachers. Tool #5 Social mapping, to analyze adolescents’ environment
and links (and sources of information). Tool #6: Focus groups, to talk about
contraceptive methods, appropriate use of condom, HIV / AIDS and STDs.
Also to discuss on the videos provided by PROMUNDO on social constructed
gender roles. Tool #7: Body mapping and drawings, also to explain how our
bodies function. Tool # 10 has been adapted: in the internal team we have
spoken about CARE's programmatic principles and RBAs, with the
adolescents we have talked about rights of men & women and which would be
the conditions to create an enabling environment for rights' realization. One of
the issues of main interest was the self-production of information /
communication tools by the adolescents themselves (theater, posters, leaflets,
radio messages, testimonies for peer education, etc). We provided the
adolescents with tents, sound equipment, etc to facilitate this. We also
provided some table games to contribute to better socialization in the Young
Area (“Zona Joven”) amongst peers. Constructing a “secure area” for the
adolescents to be confident enough to share their insights and reflect on their
attitudes and beliefs.
iv.
What are your particular strengths in FP/SRH programming?
iv. a. On our strengths, our projects working SRH have been:
a) The Multi-sectoral Population and Community Participation Project
(MSPP) (1993-2002), benefited more than 170,000 families (150,000 women)
with information, education, and communication (IEC) programs on the issues
of family planning, maternal health and sexually transmitted diseases (STD),
and HIV / AIDS. The project also ensured access for 150,000 women to
modern family planning methods and services. This project involved the
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beneficiaries and local organizations in its design, implementation, and
evaluation, and managed to ensure that both the Ministry of Health (MOH) and
communities made more efficient use of resources, self-management of
capacities, mutual learning, and dissemination of lessons learned. Sharing the
risks, progress, and strategies of the program helped to increase the
empowerment of local communities and improve relations between the
government and communities/civil society. MSPP also helped the MOH to
enhance the quality of, and increase access to, health services, by providing
training to professional providers and technicians (facilitators) from 429 health
facilities, as well as supervision of 2,000 volunteer promoters and community
committees.
b) In Ayacucho Region, between 2000 - 2005, CARE, together with the
University of Columbia and the Peruvian Institute of Maternal / Perinatal Health
and the regional Government of Ayacucho implemented a successful Project
oriented to improve the availability, quality and utilization of Emergency
Obstetric Care (FEMME1). FEMME contributed to reducing Maternal Mortality
in Ayacucho by half, from 35 maternal deaths in 2000 to 15 in 2005.The impact
assessment of FEMME project, commissioned and managed together by
CARE and the MoH, validated 8 strategies of intervention, which have been
taken as a national reference model to prevent maternal deaths by the MoH: 1)
Standardized management of obstetric emergencies; 2) Regional training
system in obstetric emergencies; 3) Standardized formats and use of UN
Process Indicators (for availability, use and quality of Emergency Obstetric
Care); 4) Clinical auditing, to review standardized management of obstetric
emergencies; 5) Referral and Counter-referral System; 6) Prevention of
infections in obstetric and neonatal centers; 7) Application of Human Rights,
Gender and Interculturality approaches in health services, and the promotion of
regional public policies to reduce maternal mortality; 8) An implementation,
monitoring and supervision system for obstetric emergencies. Supported by
LIFT UP and Country Office resources, the detailed implementation guides and
costing of those 8 strategies are in the process of being finalized.
c) From December 2003 to March 2008, the Health Rights Program
(“Improving the Health of the Poor: A rights-based approach”) partnered with
ForoSalud, the main Peruvian civil society network in health. ForoSalud
supported diverse womens organizations that developed strategies of defense
of Sexual and Reproductive Health priorities, which were facing a backslash
generated by decisions promoted by President Toledo’s first two Health
Ministers, linked to conservative groups in the Catholic Church (Opus Dei).
Adovcacy and social communication campaigns succeeded in generating
changes, and the National SRH Strategy and use and dissemination of modern
family planning methods were approved again in 2005.
d) There is also an important element of work on SRH within the Global Fund
HIV Projects, for which CARE is Principal Recipient for the grants under the
2nd, 5th and 6th Rounds, including peer to peer education with adolescents, and
work with excluded groups (MSM, CSWs, trans), as well as the SII study on
sex worker empowerment carried out in 2008. All those initiatives and the
information provided are an additional source of knowledge to be shared
through SAA methodologies.
1
FEMME: Fundamentos para mejorar la atención de las emergencias obstétricas)
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e) As a result of this process of a shift from projects to programs in CARE
Peru, all of our programs (and nearly all projects) have advocacy objectives or
activities, focused on addressing the enabling environment, with a focus on
equity and exclusion (and so also focused on social positions). Also, it is worth
mentioning that we have added “and addressing unjust power relations” in the
LAC region to the first Program Principle specifically to ensure an explicit focus
on the sorts of change the SAA approach seeks to generate.
f) Participatory Voices Project looks to strengthen the capacities of national
and regional civil society networks to design, implement and strengthen
effective strategies and mechanisms for a) social monitoring of health and
social development programs and services; b) participatory construction of
health policy proposals; and c) advocacy to improve health and social
development policies / programs.
Working with rural women community leaders, the project has provided key
information on health rights and entitlements for services available from health
facilities, and after sessions of participatory design and analysis, community
women leaders have been supported to overcome their natural reluctance for
going to the health facilities or to consider themselves actors in demanding and
negotiating the fulfillment of their own rights (improvement in social
recognition). Key additional strategies have been alliance building with the
Regional Human Rights Ombudsperson´s offices and dissemination of social
communication of health rights entitlements, to promote an enabling
environment. The project also works on building political will of health
authorities and regional government, as without this component, the
possibilities of facilitating a responsible dialogue and more accountable health
networks become extremely difficult.
g) AHMAR Project has been generating more responsible masculinity
amongst adolescents in Ascención district, Huancavelica, the poorest
department in Peru, where 82% live below the poverty line. AHMAR has
promoted participatory reflective analysis and capacity building amongst male
and female adolescents and their peers, for a better recognition of their
masculinity and feminity, and a better, informed and equitable control of their
sexual and reproductive rights (and responsibilities).
h) No Woman Behind Project, which looks to a) propel citizen surveillance of
Maternal Health services in two districts of Puno (Ayaviri) and Huancavelica
(Yauli); to b) build capacities within the Peruvian Ministry of Health and
advocate health authorities to hold health providers accountable on the quality
of health services and to c) implement social communication strategies to
propel better information on health rights and entitlements amongst rural
women and health services’ users.
In recent years, CARE Peru´s Health Program has evolved from a projectbased approach into a program-based one, integrating a wide range of health
interventions, seeking to contribute to equitable fulfilment of national and
international targets (including MDGs 4, 5, 6 and 7). CARE Peru’s Health
Strategy is built on the basis of our interventions of fight against HIV/ AIDS and
TB, our Health Rights Project Participatory Voices Project and Sexual and
Reproductive Health Projects (including Maternal and Neonatal Health &
Family Planning, Masculinities, etc), as part of a coherent conceptual and
strategic body of work.
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iv.b. On our strengths, there is sound evidence that FP / SRH is and will
be a priority for our Country Office for the next years:
As mentioned above, the Peruvian MoH has sanctioned a national norm which
considers the 8 FEMME strategies as a reference for intervention nationwide in
improving access to and quality of emergency obstetric care. The
instrumentalization (detailed guides for implementation of the strategies) and
costing studies (currently ongoing) are key tools for the nation-wide extension
of the experience, which actually is being piloted in Ancash Region, financed
through Social Responsibility funding of the Antamina Mining Company. The
initial year´s outputs have led Antamina to extend its maternal and neonatal
health project in Ancash.
In recent months, and as result of advocacy and technical assistance
strategies, the initiative of promoting popular/social oversight of quality of
maternal health care - based on the models being developed in our Health
Rights / Participatory Voices Projects and most recently with No Woman
Behind, the Field Project of the International Initiative on Maternal Mortality
and Human Rights - has been considered by the Peruvian Ministry of Health a
model to build on for the promotion of citizen surveillance, a key strategy they
are promoting as part of the Government´s Flagship Universal Insurance
program, as an innovative citizen participation mechanism.
CARE is the coordinator/facilitator of the National Initiative for a Safe and
Healthy Motherhood, which brings together different stakeholders (MoH,
Congress Commissions, Professional Bodies, Academy, NGOs and donor
community). Indeed, CARE Peru and UNFPA are about to sign an agreement
to work together to promote Sexual and Reproductive Health within the
framework of MDG5, with emphasis in reduction of maternal mortality and
family planning, both nationally and in the region of Ayacucho.
iv.c. What are your particular gaps in FP/SRH programming?
Although the important advances in SRH, the priority given to reduce Maternal
Mortality and the success of appropriate emergency care interventions within
the Ministry of Health has placed FP in a second level of priority. Along the
early 2000s, Peruvian Ministers of Health successively underestimate the
importance of family planning, due to their strong catholic personal beliefs
(2001 – 2004). After that period, the re-orientation of main international donors
(i.e., USAID) towards health sector reform projects also contributed to make
family planning less visible. FP was not part of any big health project funded
through international co-operation agencies.
On that basis, one of our main challenges is keeping the skilled people
together within CARE, especially when we are working on a project – funded
basis. Risks of high turnover of skilled, trained social development workers will
always exist, as you need projects to cover health team members’ salary.
Actually, CARE Peru could loose high skilled, committed people like Richard
Ccencho or Fernanda Loayza if we can not afford paying their salaries.
Another gap that is just filling in is the need of working Family Planning and
SAA both with men and women, both with young adolescents and their
parents, both with school students and their teachers, both with health services
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users and health providers. Occasionally, Projects are oriented to one single
actor, while reality demonstrates us that it is needed a multi-level, plural
intervention, adapting specific messages, tools and methodologies to the
context and culture we are engaging with. There is a strong need of
appropriate capacity building, both with rights holders and duty bearers.
Last, but not least, is the issue of public systems and decision making which
are far from the people or stake holders. Hierarchical, non participatory
environments are less appropriate for successful processes of sustainable
change.
iv. d. How has this initiative enhanced your FP or SRH programming?
The initiative gave us a better insight on how we could create solid linkages
between Family Planning and MM and SRH as an integrated approach. The
incorporation of SAA contributes to deeper analysis and better strategic
planning of our interventions. Our engagement with young adolescents is
understood as an accumulation of different ways of knowledge, and not just the
provision of a single knowledge. The other main tool of this is the importance
given to knowledge sharing, which is paramount, both within CARE and
outside CARE.
v.
What has been most helpful in this project?
-
Knowledge and experience sharing between Project team and
adolescents (men and women).
Knowing and applying SAA Approach
Working with school teachers on masculinities.
Facilitating the production of adolescent’s own social
communication materials.
Addressing violence as a misunderstood characteristic of men.
Analysing changes with the adolescents
Listening to our sons and daughters
Supporting the adolescent’s proposals on issues to talk about,
methods to implement, etc.
c. Knowledge Sharing:
a. How did you incorporate learning from other countries in your
project?
AHMAR draws on the basis of the experience of PROMUNDO Institute (Brazil),
on the issue of working with young men as peers addressing gender inequities,
gender violence and SRH, though PROMUNDO has developed within an
urban context, and AHMAR faced Andean culture in an extreme poverty
context.
As mentioned, lessons learned and especially the methodology of inter-action
with young people has been shared with CARE Bolivia’s Health and Education
Team (21 to 24th, May 2009), who were implementing a pilot project on
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masculinities within the Education sector. Both Peru and Bolivia teams have
analysed each other’s approaches, tools and methodologies.
We did not had the opportunity of incorporating specific inputs from our
colleagues of the other COs within the KSI I.
b. How did you share your learning
i. Within your office?
CARE Huancavelica Regional Co-ordination Committee, which monthly
gathers the diverse Project team leaders working in Huancavelica, shared the
project follow up and lessons learned, and evidenced interest in an internal
capacity building process on gender equity, masculinities, etc
Methodologies and first lessons learned of AHMAR Project together with the
importance of SAA have been shared a) with CARE Peru’s Health Program
Team, b) with our Expanded Senior Management Team, and c) have been
visited and shared with CARE’s ACD and National Gender Advisor.
Additionally, beyond the explicit inclusion of the learning achieved in the design
and implementation of the Mothers Matter Signature Program, we will also
analyze ways of replicating the SAA Approach through the community
empowerment and health service responsiveness action lines in our health
program.
ii. With your partners?
As told, one of this year’s highlights was the workshop with America Educational Institute and Ascención District Hospital Responsible of Adolescent
Health. Also, diverse meetings with Ascencion Adolescent Committee led
CARE team to share the project advances and learning methods with diverse
stakeholders and local organizations working with adolescents (Local
government, NGOs, Education officers, etc).
iii. With CARE more broadly?
Besides Bolivia Bolivia’s Health and Education Team, it is expected that
lessons will also be shared within the LAC Region´s Gender Program Strategy,
currently under development.
c.
What do you think about the different platforms used for learning in
this project:

The Teleconferences
These were the most used platform for us. Following up the SRH LAC team
teleconferences, we took part of the phone calls, though they did not have the
frequency, nor the most of our participation, as they could have. Time
constraints and other tasks prevent us of being more participative.
 Family Planning wiki - not really used, and that was our fault, at
least for English speakers.
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
SRH Listserv
Very useful. An important means of information and updating on our work,
SRH related news, opportunities for knowledge sharing and learning resources
d.
Moving Forward:
i. What are your next steps with respect to developing your FP /
SRH program? Your SAA approaches? Other?
CARE Peru, along with Bolivia and Ecuador, is one of the three tier one
locations for CARE USA´s Signature Program Mothers Matter, which will be a
key element of CARE Peru´s Health Program, building on our program
experience in Sexual and Reproductive Rights & Family Planning, as well as
knowledge built in Bolivia and Ecuador.
The Signature Program will be a key space for promoting knowledge building
and sharing on SAA, and innovative, effective strategies. This integrated effort
will be developed over the next six years, and will actively seek financial
resources and support from donors worldwide.
Locally, the Signature Program will be implemented in five regions of Peru.
One of them is Huancavelica, region of AHMAR Project.
Additionally
ii. How might the experience with SAA influence your
programming approaches during the coming 1 – 2 years?
As mentioned, our first proximity with SAA has come through the
implementation of RBA and gender equity approaches. The analysis of diverse
social factors that could prevent demand and access to SRH services – and
could also determine preferences in terms of nutrition, opportunities, home
labour, etc., within families – is present in our health projects, though reflective
analysis with counterparts will not necessarily be always valued: qualitative
research & participatory analysis are time and effort consuming, but it is worth
it. It contributes with a better community mapping and a more comprehensive
understanding of our interventions.
On the other hand, time and effort consuming methodologies are not easily
transferred to public, time-limited officers. It will be a permanent, ongoing
process, especially when working with hierarchical, traditionally “closed” public
organizations, not open to genuine participatory processes. Capacity building is
needed, also with supply-side officers, as they will ensure institutionalization of
new approaches, or at least not blind opposition to them.
It is worth also to mention that, on top of Mothers Matter Signature Program,
CARE Bolivia, CARE Ecuador and CARE Peru jointly presented a Project
proposal on adolescent SRH (PODER SER Adolescentes en la Región
Andina - POR los DERechos SExuales y Reproductivos de las y los
Adolescentes en la Región Andina) to the European Commission. The Project
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proposal specifically focused on Adolescents’ Sexual and Reproductive Health
and access to contraception (1’500,000 Euros for two years), and incorporated
masculinities and SAA approaches. In Peru, this Project was also going to be
implemented in Huancavelica and Puno, to build on our learning and social
capacities already developed on those areas. Unfortunately, the proposal was
declared “elegible”, but not selected to be implemented (a sort of “waiting list”,
with less possibilities of financing.
Project staff has learned more on adolescents’ views and understanding of
masculinities, and has evidenced changes in attitudes and behaviors of both
male and female adolescents. However, as already mentioned, lack of
international co-operation bids for SRH projects pose a main challenge,
especially when we are working on a project – funded basis, and we need
projects to cover health team members’ salary (i.e., Richard Ccencho, who
probably will leave CARE on December 2009, or Fernanda Loayza on June
2010).
We do hope Mothers Matter could also contribute to a strengthening of CARE
Peru’s health team, to keep the SAA skilled people together within us.
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