This blog was originally published on Viewpoints, the blog of Health Policy Plus.
Malawi’s National Youth-Friendly Health Services Strategy was designed to increase family planning for the country’s young people. But, to reach its goals, youth had to know what the policy could do for them. To spread the word, Health Policy Plus (HP+)—a project funded by the U.S. Agency for International Development—is helping teach young people to produce local weekly radio programs that inform youth about available family planning services.
Ensuring the health and productivity of the younger generation is essential to the country’s development. Half of Malawi’s 19 million citizens are 16 or younger, and one in five women begin childbearing while still in their teens. Malawi’s Ministry of Health launched a renewed effort in 2015 to promote youth-friendly health services for young people ages 10 to 25. The initiative gives priority to ensuring that young people complete their education, delay their sexual debut and first birth, and reduce HIV transmission.
HP+ combined the reach of community radio with the energy and imagination of young people to raise awareness of youth-friendly health services (YFHS), the importance of quality education, and protection from exploitation and abuse. Parents, health providers, and religious, political, and educational leaders are engaged through the radio programs, listening clubs, and community gatherings. Meanwhile, a series of posters displayed in facilities inform service providers of youths’ rights and urge them to be respectful and nonjudgmental.
With a platform where they can talk openly about their reproductive health, youth are learning to use their newfound influence. Within the listening areas of the project, more youth are visiting youth-friendly facilities and accessing services, among other positive results that have been measured during the life of the project.
Radio Programs Produced by and for Youth
Building upon earlier work with community radio stations in Nkhotakota, Mchinji, and Monkey Bay districts, in 2017, HP+ began training and mentoring teams of teenagers to produce weekly radio programs focused on topics related to youth-friendly health services. They were also trained on basic broadcasting and journalism skills, such as interviewing, editing, creative storytelling, and fact-checking, and how to use these skills to advocate for more accessible and higher-quality youth-friendly services.
The staff at the radio stations were trained on supportive supervision and adolescent development so they could be effective mentors to the youth. HP+ provided the stations with recorders and a desktop computer for the youth to use, and dispensed a small stipend to the students for transportation and other expenses incurred to produce the programs. Weekly bulletins are e-mailed to station staff and the young reporters providing detailed information on a different youth-related health topics each week to help them develop program themes and report stories accurately.
The programs, edited into a 30-minute radio magazine format, cover issues of concern to youth, including the need for parents to talk to their children about sex, the importance of girls staying in school, the harm of early marriage, and where young people can access counseling on family planning and health issues as well as treatment of sexually transmitted infections. The youth also produce public service announcements that are broadcast daily with brief but bold messages for girls about the right to say no to sex and to demand that their partner use a condom.
After the initial HP+ training, youth continued to produce the programs on their own. In the first three listening areas, after eight months, 60 percent of youth and parents surveyed had heard of the government’s youth-friendly health services policy, whereas none had heard of the policy previously. HP+ then began working with two additional stations: one around the town of Nkhata Bay and another in an isolated community in the northern part of Nkhata Bay district, where it is the only radio signal received. As part of the training to onboard the new stations, two youth from the original Nkhotakota station shared their experience and tips for engaging young people and developing program topics.
Combined, the five stations reach about 3.3 million listeners. Around 200 youth ages 14 to 19 have been trained, some to produce radio programs and public service announcements and others to be part of listening clubs that help to drive the program content.
Listening Clubs Keep the Momentum Going
For each station, three listening clubs of about 10 members each were created: one for boys, one for girls, and one for boys and girls. The clubs meet weekly to listen to the radio program, discuss the issues raised, and provide feedback to the program producers and suggest future topics. Informal listening clubs have also been formed and they send their thoughts to the weekly programs via Facebook, WhatsApp and text messages.
Members of these listening clubs, some of whom are also helping to produce the weekly programs, are driving results. For example, one youth created and hung posters about youth-friendly health services in his school and around the community; a girls listening club organized a rally and dance performance that attracted 2,000 young people; and a boys club is working with other youth clubs in the community to share information about youth-friendly health services at their local hospital and clinic. Also driven by the clubs, some teachers have added discussion of youth-friendly health services to their life skills classes.
Community Gatherings Engage Religious and Tribal Leaders, Health Officers, and Others
Once a month, staff at the radio stations work with student reporters and listening clubs to organize community gatherings of about 150 to 500 people from the local area, including tribal leaders, teachers, religious leaders, health officers, and parents.
Usually meeting in an outdoor common area for two to three hours, community members hear from district health officers, local members of parliament, and others about youth-friendly health services, and attendees discuss the issues brought up in the youth radio program. Stations that are able to occasionally air these group discussions live; when that’s not possible, student reporters interview people in the crowd on the topics being discussed to use in a future radio program.
Leveraging Social Media
In addition to airing the public service announcements on the radio, they are also being promoted on Facebook and WhatsApp. In addition, the project is training youth to produce short videos (using their phones) that amplify the messages from the radio programs and public service announcements. One of the videos shows how to ask a partner to use a condom; another features a rapper encouraging youth to visit a youth-friendly health clinic. More than 9,000 people watched the first series of videos.
Posters Urge Service Providers to Support Youth
Complementing the radio programs, a set of posters were developed that target healthcare providers to enlist their help in protecting Malawi’s youth. They explain to providers that young people have a right to family planning and other health services, and urge providers to be respectful and nonjudgmental, to protect the privacy of youth, and to provide convenient hours and locations. The young people participating in the radio project posted the posters in clinics in the listening areas of the three initial stations, as well as in their schools.
Results Seen Throughout the Communities
With information, involvement, and encouragement, young people can generate support for and use of youth-friendly sexual and reproductive health services. Our results show that:
- In Nkhotakota, Mchinji, and Monkey Bay districts, after eight months, 60 percent of youth and parents surveyed had heard of the government’s youth-friendly health services policy, compared to none previously.
- At Monkey Bay Community Hospital, in the area where Dwimze Radio broadcasts, 228 youth sought condoms at the facility over a five-month period, whereas previously, none were sought at the facility; youth seeking other family planning information and services rose from 33 to 191; and the number of young people receiving HIV testing and counseling services rose from 61 to 478.
- At the district hospital in Nkhotakota, over a five-month period, three times as many youth received condoms by the end of the period, and HIV counseling and testing services provided increased from 18 to 398.
- At the Mchinji district hospital, condom distribution nearly tripled over a nine-month period, from 428 to 1,273, and youth inquiries about services rose from 106 to 509.
- In the town of Nkhata Bay, a facility expanded its hours to accommodate students after hearing about the inconvenient clinic hours on Chirunda Community Radio.
- In Nkhotakota, five village chiefs put in place bylaws that penalize parents whose children marry before the legal age of 18. Religious leaders in the district are regularly speaking to their congregations about the need for parents to talk with their children about sex.
Some of the problems identified at the start of the project persist in certain locales, among them inconvenient hours at clinics, a lack of youth-friendly health services in some remote areas, and unfriendly staff and lack of privacy at some health facilities. However, changes that have been achieved motivate the youth to continue to produce the programs, bring their peers aboard, and exercise their rights. As Charles Rice, who runs the training partner organization Developing Radio Partners, said, “The stations are the vehicle, but the youth are really driving this. We’ve given them the car keys.”