UNFPA Lebanon - SIDC Project

Reproductive Tract Infections among Young People:
“A Social Franchising Approach to Prevention”

BACKGROUND AND CONTEXT
The Reproductive health programme in Lebanon currently supported by UNFPA under the 2nd program cycle 2002-2006 is being implemented by several governmental and non-governmental partners and focuses – among others - on the youth group given its specificity, needs, and required services.

As clearly stated by Steven D. La Vake (1) : “some programs serving youth are using social franchising techniques, even if they do not think of themselves as being part of a franchise system, or have never heard of the term franchising”. The RH programme in Lebanon does apply selected components of a social franchising package including physical improvement and set up of SDPs, training and skills development, reproductive health package integrated within primary health care, IEC/BCC activities, operations systems (i.e. MIS/HIS), establishment of a network system, technical assistance, and process evaluation to name but a few. The provision of youth SRH information initiated in Lebanon has already expanded beyond the health settings into the community in several regions of the country. This approach proved to be effective and culturally acceptable and welcomed in the communities by establishing alliances and coalitions with traditional and non-traditional groups. However as demands are being created, supplies must be made available in the health settings that need to become more youth friendly to attract the young population to the SDPs and in other potential settings.

A number of interventions and strategies are being undertaken or will be carried out under this cycle that do indeed provide a framework or complement the proposed interventions and activities under the RTI project. Therefore, it is proposed that the Lebanon project on “Social Franchising Approach to RTI Prevention among Young People” builds on existing and/or pipeline interventions and activities based on their feasibility, complementarity, and added value. Specifically, the following CP related activities are proposed to be link up under the RTI initiative:

It is proposed that 2 out of the 5 Centers of Excellence (COE) - one NGO and one Ministry - will be selected for this RTI project. The COE were selected given some criteria such as provision of a full range of RH services including RTI screening and prevention, availability of a core team of service providers, establishment of youth friendly services, and referral centers where possible. The 2 COEs were provided with equipment and supplies including mini-labs. One of the COEs (ran by a national NGO) selected for this project would be located in the outskirt of the capital - Beirut – and which caters for a low to middle socio-economic class population. The other COE will be identified shortly.
The current RTI project will also build on UNFPA’s support with the Ministry of Public Health aiming at strengthening the skills of service providers – including the COEs- in providing quality RH services and based on a regular training and monitoring plan. Quality of care tools such as Standard Clinical Operating Procedures (SCOP) developed in 2000 are used in developing capacities of the service providers in RH including RTI. It is envisaged that in 2005, these protocols will be revised to 1) introduce modifications and changes identified in the past 4 years by the service providers using these normative tools, and 2) tally the protocols with the services geared towards youth particularly in the COEs.
In addition, the RTI project will benefit enormously from the Global Youth Partners initiative which will be working towards advocating to local and sub-regional decision makers for increasing access of young people to HIV/AIDS services and information as part of the youth friendly services package in the COEs. The novelty in the GYP initiative is the empowerment of young people that was translated into their full participation in the conceptualization, planning, implementation, and monitoring of the interventions. It is also envisaged that the advocacy efforts of the GYP will lead to expanding the RH YFS to recreational/leisure settings for facilitating access of young people to RSH services without any discrimination. Indeed the fact that this GYP team of 7 young people will be implementing their advocacy campaigns in local communities, this approach will provide an opportunity for empowering these communities to apply the franchising approach.
The BCC project implemented at the community level and targeting young people has gained grounds in the past 5 years and mobilized a group of young people trained for undertaking outreach activities through a peer based approach. The project produced a complete set of entertainment education “edutainment” material and tools that were tested among the youth and introduced in the non-formal sector. It is expected that these material will be assessed for introducing them in the school sector.
A baseline study on counseling is currently being undertaken and aims at a) defining the counseling services being offered in various SDPs, b) identifying capacities and competencies in counseling available in the SDPs, and c) proposing a training plan on counseling based on the needs. A counseling manual/segments of the SCOP will be developed for ensuring quality counseling services in RH.

Situation analysis. Three operational research will be carried out as follows:

1.1. Situation analysis/mapping of RTI services available in the defined community where a COE exists. The situation analysis will be done through a) collecting and reviewing quarterly reports of the COE, b) semi-structured interview of service providers of the COE, and c) semi-structured interviews for clients.

1.2. Operational research among young people including selected students in the vicinity of the COE. This study will aim at assessing the perception of young people of the COE services, their views for ideal services and information, and what is needed and required to make the services in the COE youth friendly and easily accessible.

1.3. Situation analysis in the community where the COE is located with the aim of assessing the perception, values, attitudes of the community on RTI prevention services to youth, and for identifying possible settings for expanding the services beyond the COE within the social franchising approach
Quality Assurance: Review of the Standard Clinical Operating Protocols (SCOP) with the aim of updating them with sections, information, and guidelines for providing RTI prevention services to young people.
Capacity building of services providers in the selected COE on RTI prevention through the use of the revised SCOP. They will also be trained on counseling skills based on the findings of the counseling study and related manual. A training package will be developed for this matter.
Procurement of equipment: there may be need to procure additional equipment for the COE following the mapping exercise.
Promotional material: Design and produce specific material and promotional items on RTI prevention building on a) the experience of the BCC project as well as the GYP team given their knowledge of the community and b) the findings and results of the situation analysis as evidence base. This material will be used among the youth in and out of schools, service providers, and community groups. Branding of the services will be promoted in the COE and beyond it through a logo, symbol, etc
Social franchising: Introduction of social franchising approach. This will entail learning the techniques and methodology for applying it within the context of this project.

A local NGO, the Armenian Relief Cross in Lebanon (ARCL) will be entrusted with the overall implementation of the project activities. ARCL was selected on basis of its wide outreach to the Armenian community, and given that it is one of the COEs to be. More so, ARCL has the experience in providing RSH within primary health care with specialized staff trained on the SRH SCOPs, and participated in youth related campaigns in SRH. A project coordinator will be recruited for the project duration (i.e. October 2005-June 2006) to follow up and coordinate all projects activities. An advisory committee will be created to advise on the project’s activities. UNFPA office will ensure proper implementation and monitoring of activities and will provide required overall guidance

Proposed workplan of the Reproductive Tract Infections among Young People:
“A Social Franchising Approach to Prevention”- LEBANON

(1) Steven D. LaVake: Applying Social Franchising to Youth Reproductive Health/HIV Services, Youth Issues Paper 2, Family Health International - 2003