Omisión

While collaboration could have also been discussed under organizational capacity, there are elements of it that are related to the other themes; as such it is best discussed separately. Collaboration captures key informants discussions about how organizations and programs work together to provide ASRH education, advice and services. Most organizations/programs discussed working together through formal or informal collaborations regarding ASRH programming. However, informal collaborations did not involve any written agreement or contract, and were more often discussed. In contrast, formal collaborations were binding via contractual agreements.

Resource Sharing

Informal collaborations often took the form of resource sharing. For example, most key informants discussed that they facilitated training or health promotion activities planned by other organizations, implemented programs or research for other organizations, shared health promotion paraphernalia, and even referred clients to other organizations for more appropriate services for their concern. The following key informant in the NGO sector discusses how other sectors are involved:

Training programs with young people include HIV/AIDS issues, and volunteers from across the sectors facilitate these trainings to deal with sexuality and HIV. For example, Ministry of Education is involved.

(Key informant 6, IE)

When asked about how the organization works with other organizations, this key informant in the HCCS sector described an informal referral service:

There is a very informal arrangement. For example there are women who need services because of violence against women, you know, abuse and so on. We do referrals with Legal Aid and Counseling Clinic [LACC], so we have that kind of loose arrangement.

(Key Informant 1, HCCS)

Although ‘women’ is used in the above excerpt, the key informant later clarified that adolescents are also referred in this manner. Nonetheless, referral is an important aspect of integrated services, and may have implications for the Grenada context considering that there are no specialized ASRH services. However, the fact that referrals are done informally rather than through a formal process has implication for continuity of care during help-seeking.

Only one formalized collaborative activity was discussed. However, based on the key informant’s discussion, the collaboration may have been formalized because it involved the regional arm of an international agency for a program targeting adolescents and young people.

In general, it appeared that collaborations provided organizations and programs an opportunity to reach subgroups of adolescents that they would not have otherwise accessed.

Committee Representation

Committee representation was discussed as one of the main ways in which organizations work together. This is evidenced in the range of documents reviewed that listed the involvement of several organizations in the development of the strategic plan or policy (section 4.2). Most key informants reported that their organization is represented on the committees of several other organizations to form multi-sector committees, including related to ASRH. However, with the exception of two committees, the role of other multi-sector committees was not probed, but the roles of these committees included aspects of policy and program planning and implementation. This suggests that there is a good foundation for participatory decision-making for policies and programs, which should augur well for efforts to scale-up ASRH promotion.

Nonetheless, despite the many ways in which key informants discussed working together, collaborations were not without challenges. Some key informants discussed that information sharing was one of the weakest areas of collaboration among organizations. For example, a

key informant in the IE sector discussed that having to request data, rather than routine data sharing to inform program decisions was a weakness.

So let’s say [Ministry of] Health is the custodian of information….in terms of statistics and so I have to request it… And still I am not too happy with the statistics that I am getting because I want to be sort of able to break it down…really look at some of the issues, look at some of the areas and so forth…. I want something more specific…look into a parish and look at the villages and see exactly what is happening there and so forth…but they don’t have that sort of statistics.

(Key Informant 5, IE)

Keeping organizations abreast of programs being planned and following up with updates on committees’ initiatives were also discussed as a weakness. For example, one organization reported having to abandon a major program for adolescent mothers after all the ground work had been done, because they found out that another organization was planning a similar program. This highlights the issue of overlap and duplication of efforts considering the lack of financial resource (section 4.4.1), in addition to the lack of an effective communication system to relay information between stakeholder organizations during and outside of committee meetings.

Another challenge is related to the timeliness of organizations honouring agreements or whether agreements are honoured at all, as discussed by the following key informant in the NGO sector:

...we could not do [the HIV Rapid Test] because CAREC and the MoH special regulations we were not able to meet that requirement….It’s about 200 [tests] - THAT WAS NOT VERY FEASIBLE, plus training had to be done by the MoH. They made many offers but nothing materialised.

(Key Informant 1, HCCS)

Although the key informant was not probed as to whether there was a formal or informal agreement for the MoH to provide training for the HIV Rapid Test, the tone of the informant and the use of offers suggest that it was informal. It is possible that by adding the administrative step of formalizing the training agreements may have helped to accelerate the process or at least inspire confidence that the agreement will be upheld.

4.5 Chapter Summary

While several legislative and policy documents have been indentified that relates to ASRH issues, evidence suggests that some legislation and policies are unclear. The findings suggests that parental consent for SRH services policies may be based on health worker practice over time, rather than a written policy since no legislation or policy document was found. Furthermore, the main policy and planning document that gives guidance on SRH is reportedly not being used (i.e. NSPH). And, the contents of several sections of legislative and policy documents suggest issues of: gender inequality; discrimination based on age and sexual orientation, and; whether the penalties attached to laws may be hurting or helping ASRH seeking. However, a few recently updated policies and laws may augur well for ASRH.

Regarding ASRH services, HFLE can be considered the only adolescent-friendly program provided, however, no adolescent-friendly health services were identified. Nonetheless, public health facilities which target adult SRH and the school system have the ability to reach the most adolescents, since they are dispersed across the island. Apart from these two government programs, other notable organizations are in the NGO sector and include:

GRENCODA and ART in rural communities that reach both in- and out-of-school adolescents, GPPA and LACC in the Capital, and the GRCS and the NPP that have some reach across the island.

Finally, key informants were unanimous in that they perceived that the existing environment around ASRH promotion is not adequate to meet the SRH needs of adolescents. Their reasons for this are categorized as: Organization capacity, implementation and enforcement, and coordination and collaboration.

Having examined the existing environment around legislation, policies and services in Grenada, chapter 5 discusses the SRH concerns adolescent participants discussed and the pathways they describe for coping with some of those concerns.