Traducción y replicación (transcripción)

This story of change describes the A+ programme work of the Nicaraguan sexual and reproductive health provider, Profamilia, with young people in different parts of the country, in the context of sexual rights in Nicaragua. From feedback from young people, and the reflections of different

stakeholders on their perspectives, the Panos London assessor has derived insights into the role and added value of Profamilia and the International Planned Parenthood Federation (IPPF) to strengthen young people’s access to sexual and reproductive health services and rights in Nicaragua, in the past and in the future. The story is drawn primarily from interactions with members of Profamilia’s youth clubs who participated in the research workshop, as well as with staff and other stakeholders. It focuses on the issues, activities and changes that young people chose to share in the workshop and the role of Profamilia in supporting these.

One of the main principles guiding this review of the A+ programme assessment is the value of putting youth themselves at the centre of the assessment, through participatory research with youth project participants at the start of country visits. In the workshops, young people provided details about the reality of their lives and what was important to them. In this way, the context, findings and issues revealed through the workshop guided interviews with Profamilia staff and other key actors and other information gathering during the Panos London assessor’s country visit. Profamilia works in very challenging and complex situations in relation

to youth sexual and reproductive health and rights. This story demonstrates the effectiveness of responding to these challenges by adopting youth- centred strategies organisationally and through programming that addresses the social barriers to accessing sexual and reproductive health services. It seeks to convey the complexity of working on sensitive, controversial and, above all, very personal issues which affect individuals’ lives, but also community and social dynamics. It highlights the difficult balancing act between social, health and financial objectives that Profamilia has to manage, and the relationship between these dynamics and tangible programmatic outcomes.

Profamilia is an NGO and not-for-profit health care provider with social objectives. A member of IPPF, it has been working nationally for 40 years, providing sexual and reproductive health and primary health care services through a network of clinics. Although Nicaragua has a free public health service, Profamilia works to provide complementary services at low cost, often working with local public services to reach the most vulnerable and underserved people. In response to the high proportion of young people (65 per cent of the population are under 30 years and, according to the 2005 census, over 49 per cent are under 192_{), and the highest rate} of teenage pregnancy in the hemisphere, Profamilia has a strategic focus on youth services. The organisation runs youth-friendly services with specialist staff and facilities out of several of their clinics. They also invest heavily in young people’s participation, both in reaching out to the youth with information and services, and in the organisation’s own governance and decision-making structures.

‘ For people to attain the highest standard of health, they must first be empowered to ecercise choice in their sexual and reproductive lives; they must feel confident and safe in expressing their own sexual identity… ‘ IPPF is committed

to fulfilling its goals through an approach that embodies the principles of universality, interrelatedness, interpendence and indivisibility of all human rights.’ Sexual Rights: an IPPF declaration

Profamilia was one of 16 IPPF Member Associations that benefited from a three-year grant from the Danish International Development Agency (Danida) called the A+ Programme. The A+ Programme was implemented in 2010 – 2013 and had four main objectives:

1 To increase institutional commitment of IPPF Member Associations to young people’s sexual rights

2 To build a supportive community, environment, and legal framework for young people’s sexual and reproductive health and rights.

3 To strengthen and expand existing services for young people, especially the most underserved and vulnerable.

4 To increase access to comprehensive, youth-friendly, and gender sensitive sexuality education.

The IPPF A+ project has allowed Profamilia to strengthen and deepen its focus on youth, and invest in expanding its youth-friendly services. They established youth clubs associated with their clinics where young people have learned about sexual health and rights, promoted the youth-friendly services available at the clinic, and been involved in local advocacy around young people’s sexual rights. Most importantly for them, they have built strong social relationships with each other, built their own self-esteem and awareness and their attitudes to sexuality and rights have matured. This case-study research, which represents one of four international

cases, lies within the context of a full assessment that also includes a desk review, survey of all of the Member Associations implementing the A+ project, and interviews with the global and Regional Offices of IPPF. The main objectives of this in-country and regional research are to: „

„ Explore understanding of different perspectives, including youth perspectives on sexual and reproductive health and rights „

„ Understand what it is like to be young and how rights are realised in different contexts, including reviewing how change happens and

understanding what mechanisms or strategies in different contexts result in desired outcomes for young women and young men; and

„

„ Consider how the A+ programme has contributed to these desired outcomes.

The Panos London assessor met with 10 young people who are involved in youth clubs attached to four different Profamilia clinics, Chinandega, Los Robles (Managua), Somoto and Tipitapa, the last three of which have established separate youth-friendly clinic services with A+ funding. Over three days in a participatory research workshop, they shared many

of their thoughts, feelings and achievements in relation to Profamilia, sexual rights and health and progress towards their vision of positive sexuality. The results are the basis for this story.

I decide:

„

„ What is appropriate for me: I am faithful to myself. „

„ Who I want to be with „

„ The right moment to start sexual relations

I need:

„

„ Information on relationships, sexuality, family planning and physical development „

„ Communication, with my partner, family, friends. „

„ Consensus decision-making, respect and tolerance „

„ Prudence and judgement Positive sexuality: by the workshop group

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The methodology used for the in-country participatory research portion of the assessment has been produced as a guide and made available to IPPF Member Associations and IPPF regional offices looking to generate and document similar types of insights and information with young people.

Methodology

Given the complexities of sexual reproductive health and rights and young people’s lives, the best way to summarise the findings is in the form of a critical story of change. This story approach allows the assessment team to explain the findings of the participatory research component in an integrated way, in the context, and in relation to other information gathered through interviews and as background information. The participatory research activities and use of the story of change format encourages reflection and learning from the findings with the young people themselves, as well as with Profamilia and IPPF Regional Office staff. The outcomes from reflection and discussion create a loop of additional information to feed into the assessment.

Analysis and discussion and findings and recommendations will be carried out in the next phase of the assessment, which will be added to the case study stories of change for each of the four countries, as well as becoming part of the wider A+ programme assessment.

This story conveys the main findings of a field visit by Hannah Beardon, a member of the Panos London A+ assessment team, to meet stakeholders of the project and to find out more about the change processes related to sexual reproductive health and rights of young people involved in Profamilia programmes in Managua and Somoto, in October 2012. The visit to Nicaragua centred on a five-day participatory research process with a group of 10 young people (six girls and four boys aged between 15 and 24 years), directly involved in the project as members of the Profamilia youth clubs and peer educators.

Using games, drawing, group work, discussions and photo-story techniques, participants explored what sexual rights mean for young people in that context, what kind of changes they wanted to happen and what has already started to happen, and how these changes come about.3 _{To bring} these discussions alive, participants made and shared their own audio- visual stories of change. Participants also created presentations about their activities and experiences with Profamilia, as well as photo stories to illustrate and explore in more detail the changes happening in their own communities. At the end of the workshop, the Panos London assessor checked her interpretation of what she had heard with the young people in a presentation.

To validate and give more texture to these findings, the Panos London assessor visited a Profamilia club and youth-friendly clinic in Somoto, where she met with and interviewed people from local civil society, police and public health, as well as national partners. She was also able to check and discuss her findings with the project management team who accompanied her throughout her visit.

Using these presentations, she went back to visit the staff and management of Profamilia to understand the strategic priorities and direction of the organisation, and to report back and hear their reaction to what she had learned at the grassroots. This brought out interesting insights into how the organisation manages social change, financial and health service priorities, and how this work can be built on and outcomes and impact further strengthened, which are reflected in the story of change in this section.

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http://www.eclac.cl/publicaciones/ xml/5/22695/lcl1744i.pdf 5

According to a World Bank report, in 2007 72% of married women used contraception compared with only 27% in 1981. See http://siteresources. worldbank.org/INTPRH/Resources/ 376374-1278599377733/ Nicaragua62910PRINT.pdf 6

CIA factbook https://www.cia.gov/ library/publications/the-world- factbook/geos/nu.html