Impact of Youth Peer Education Programs: Final Results from an FHI/YouthNet Study in Zambia

Carried out by Family Health International (FHI)/YouthNet, this study sought to determine the effect of youth peer education (YPE) programmes on sexual and reproductive health (SRH) behaviours among youth.

In Phase 1, conducted March 2003 - December 2004, 4 successful YPE programmes in Zambia and the Dominican Republic were followed, using a descriptive, process evaluation approach. Phase 1 data were used to develop 8 checklists: Technical Frameworks, Youth-Adult Partnerships, Youth Involvement, Peer Educator Cooperation, Gender Equity and Equality, Parental Involvement, Stakeholder Cooperation, and Community Involvement. These checklists helped in identifying core elements believed to be important for sustainability and peer educator retention. Examples include the importance of sound programming standards, trusting and respectful youth-adult partnerships, balanced youth involvement, gender sensitivity, good cooperation between the programme and gatekeepers/stakeholders, and active participation by the local community.

Conducted in Zambia from February 2005 to August 2006, Phase 2 sought to link the quality of YPE programming to SRH behaviours. Instruments developed in Phase 1 were used to measure quantitatively the core components of YPE programmes, including inputs (programme quality and program processes using the 8 checklists and information on costs and expenditures) and outputs (peer educator activities) in 5 YPE programmes in Zambia. Data gathered were linked with exposure to YPE programmes and outcomes of these programmes; exposure and outcomes were measured using population survey data and clinic-based data.

Population-based survey data found that YPE exposure in Zambia was high and was associated with outcomes such as higher HIV knowledge, increased intentions to use condoms, lower stigma and discrimination towards people living with HIV/AIDS (PLWHA), and increased likelihood of using a condom at last sex with most recent partner. Youth attending the clinics affiliated with the study were especially likely to have contact with YPE. According to data from 10,300 15-24-year-old clients attending the 7 study clinics, 74% were exposed to YPE. Making appropriate referrals for HIV testing was an intense focus of the YPE programmes in Zambia, and according to data, over half (53%) of 15-24-year-olds attending the study clinics were referred to the clinic by a peer educator. In short, YPE exposure is associated with SRH risk reduction behaviours and increased diagnosis and treatment of highly vulnerable youth.

However, the study also reveals the wide variation in the quality, impact, and cost of YPE programmes; a small number of high-quality programmes appear to be responsible for impacts measured in the clinical and national surveys. The highest quality programme was also the most expensive overall and per peer educator (PE) trained. No one domain of quality stood out from the rest, as measured by the 8 checklists. With the exception of the Parental Involvement Checklist, on which all programmes scored low, programmes tended to either score high or low on all of the checklists. In terms of outputs, peer educators from the highest quality YPE programme on average spent the longest hours working on YPE activities, conducted the most activities, covered the greatest number of health topics, and made the largest number of contacts. Condom distribution was the most common activity.

"We believe that the eight checklists can play an important role in designing and implementing effective YPE programs. This study suggests an urgent need for the development of evidence-informed YPE guidelines and minimal criteria for YPE programs at the national level so that more youth are reached by high quality YPE programs. YPE programs, especially when closely linked with clinics, have a strong potential to improve knowledge and attitudes and reduce SRH risk behaviors among Zambian youth."