Throughout the year 2003, the Adolescent Health and Development Program (FCH/CA-ADH) has been developing a conceptual framework and strategies for its new plan of action. The plan is based on a life cycle approach in step with the rest of the Child and Adolescent Health (FCH/CA) Unit, as well as with adolescent determinants of health. The FCH/CA-ADH Plan of Action for 2003-2006 responds to the needs of adolescents and youth of both genders and different age groups between the ages of 10 and 24, and focuses on the most vulnerable adolescent populations in priority countries. The plan also seeks to address current and emerging needs in adolescent health, particularly in the areas of violence, teen pregnancy, sexually transmitted infections and HIV/AIDS.
Lines of Action
Adolescent Health and Development has developed six lines of action for supporting countries, each of which has resulted in notable success in the Region. Results were obtained from an external evaluation of our work conducted in 2001.
1. Support the Countries in Developing Policies and Capacity for Advocacy
PAHO has helped facilitate the process by informing legislators of other countries' experiences, and has made a concerted advocacy effort to increase commitment and political support for youth policies and legislation in Latin America and the Caribbean. Successful examples can be found in Dominican Republic, Colombia and Nicaragua. Moreover, we are currently evaluating youth participation and healthy municipalities in Cuba, with WHO partnership, as a successful strategy for incorporating adolescent voices in the decision-making process. Furthermore, we supported the first Lady of the Dominican Republic in preparation for the XII Summit of First Ladies, Wives and Representatives of Heads of State and Government of the Americas in October 2003, whole theme was "Adolescence and Poverty." The conference featured considerable youth participation, the result of a previous preparatory meeting, Americas Youth Voice, held in Dominican Republic in July of that year. Youth leaders who took part in Americas Youth Voice drafted a youth declaration of rights and responsibilities which was presented during the First Ladies meeting.
2. Support Adolescent Health Services within National Adolescent Health Plans and Programs
The external evaluation of our work with the countries conducted in 2001 showed noteworthy achievements regarding the Region's National Adolescent Health Programs. In 1996, 85% of countries had national adolescent health programs; that figure rose to 95% in 2001. Although the funding for these national programs came from international organizations and foundations in 2001, it is important to mention that 62% of the programs also received national funding, a substantial increase from 1996, when only 43,5% reported receiving national funding. This increase in country funding represents significant political and economical support for adolescent health and development. We have also developed clinical guidelines, guides, software for situational analysis and an evaluation manual. In 2002, we developed tools to support models for quality adolescent services in partnership with the Health Services Division at PAHO, with WHO support. Counseling guides for adolescent sexual and reproductive health are also under development, as well as new conceptual framework within family and community.
3. Support Human Resources Development, Including Youth Leadership
Adolescent Health has focused on building capacity at the country level through pre-service and in-service training. Four universities have designed competence-based courses available on line, on paper and in CD-ROM format. These courses have been developed in partnership with Universidad Autónoma de Nuevo León, México; Pontificia Universidad Católica de Chile; and Universidad Estadual do Rio de Janiero, Brazil. The University of Johns Hopkins in the United States, in conjunction with Adolescent Health, has designed a CD-ROM in Spanish to train primary level health care providers in sexual and reproductive health. During 2002, the goal was to disseminate the courses among other universities and governments. Also in 2002, Adolescent Health supported an innovative Adolescent Virtual Health Congress in collaboration with the University of Guadalajara, Mexico, with 780 circuit riders that marked a new way of disseminating knowledge.
Youth participation and leadership has been another successful area in developing human resources. We have developed a conceptual framework on youth participation, organized seminars and training and supported local initiatives that have provided valuable lessons learned. We have developed tools for implementing youth participation, translating the Canadian Mental Health Association's youth participation manual into Spanish. We also supported actual youth participation during the Americas Youth Voice preparatory meeting for the First Ladies conference. As a result of these meetings, plans are underway for youth leaders to forma a Pan American Youth Organization (PYO) to defend their rights and responsibilities as citizens.
4. Support Social Communication and Adolescent Health Promotion
The 2001 external evaluation showed that Adolescent Health and Development was not successful in this area, because building capacity for a social communication network was beyond the financial scope of the Plan. However, some beneficial results were obtained regarding social communication in adolescent health and development: a virtual "adolescent-friendly" journalist network to promote adolescents and youth as valuable members of society, and a conceptual framework in social marketing for adolescent health. In 2002, Adolescent Health, in collaboration with the Social Communication Program at PAHO and FELAFACS, conducted a study on "Media and Health: The Voice of Adolescents" in eleven countries. This study explored the role the media play in the health of adolescents and youth in Latin America.
Two of the Adolescent Health team's most recent Project also cover social communication: The Project Breaking the Silence Surrounding AIDS: A Regional Approach to Preventing HIV/AIDS in Young People, in collaboration with the Norwegian Agency for Development Cooperation, features as one of its goals the improvement of social communication through the inclusion of HIV/AIDS awareness and prevention messages in the mass media, while the Project Building on Lessons Learned: Youth Development and Sexuality to Prevent Pregnancy, HIV/AIDS/STIs in Adolescents, developed along with the Swedish International Development Cooperation Agency, also seeks to include messages on adolescent and youth health promotion as well as HIV/AIDS awareness and prevention in the media.
5. Support the Development of Networks and Dissemination of Knowledge and Information
Adolescent Health and Development has been able to establish a sustainable structure made up of people and institutions committed and trained in adolescent health and development. The most important achievement has been the Adolec Bireme project and the coalition of Adolescent Virtual Health Libraries (www.adolec.org) in ten countries. To better disseminate information, technical publications and tools, we created a publications catalogue and a CD-ROM containing all of our publications, which are distributed through several networks of organizations and specialists throughout the Region. In summer 2002, we created an HIV/AIDS network and accompanying quarterly newsletter.
We have also implemented a multicentric study on sexual and reproductive health of adolescent males that was presented in a ground breaking meeting held in Rio de Janeiro in August, 2002: "Young Men as Allies in the Promotion of Health and Gender Equity." Alter the meeting, we published the document "Hacerse hombres," (Becoming Men), an análisis of the Multicentric study conducted in 2000 in nine Latin American countries (Brazil, Colombia, Costa Rica, El Salvador, Guatemala, Honduras, Jamaica, Mexico and Nicaragua). As a third step, an intervention model was developed in Río de Janeiro soccer schools based on the study findings (in Spanish only)
6. Resource Mobilization and Partnerships
Strategic alliances with various UN agencies, banks, bilateral agencies, different NGOs, civil society and the private sector have been key to our success. We have also mobilized resources at the regional, national and local levels.
Currently, we are implementing several regional projects:
Integrated Management of Adolescent Needs (IMAN):
Because adolescents are the leaders of tomorrow, and knowing that health is of concern to society as a whole, the Child and the Adolescent Health Unit has created Project IMAN: Integrated Management of Adolescent Needs. The project's purpose, focused not only on service provision but also on health promotion and prevention, is to offer priority countries an integrated package of successful interventions in adolescent and youth health and development. IMAN is made up of four components covering the risks, prevalent diseases and needs of this age group: 1. Information services; 2. Health services; 3. Human resources development and; 4. Family and community interventions.
Haiti, Dominican Republic, Nicaragua, Bolivia, El Salvador and Honduras have been selected as priority countries and will benefit from this initiative in 2004 and 2005. The initial phase of the project has focused on collecting data in order to identify the diseases and risks that most affect young people, disaggregated by age and gender. Analyzing these data will allow us to identify health priorities in each country.
The IMAN strategy is based on the human lifecycle. The health of children is key to achieving a healthy adolescence, which, in turn, is necessary to attain healthy adults. The strategy is based on evidence and on lessons learned during past projects dedicated to adolescent and youth development. Centered on determinants of health, gender and risk and resiliency factors from a population health approach, its goal is to improve the quality of health services for youth with few resources, both social and economic. This goal coincides with the theme of the XII Summit of First Ladies, Wives and Representatives of Heads of State and Government of the Americas, which as held in Santo Domingo, Dominican Republic in October 2003. IMAN extends the management of childhood illnesses to adolescence, responding to the needs of youth in areas ranging from chronic diseases to mental health and HIV/AIDS, the latter of which is ravaging many countries of the Region.
One of IMAN's strengths is its integral nature. When planning activities specifically designed to improve the health of young people, the project will keep in mind the wide range of individual and collective factors and conditions based on evidence, which determine a population's health status. IMAN will focus on the principal needs and causes of morbidity and mortality in the most vulnerable adolescents and youth. Interventions will be designed at the political, family, community, health services and university levels, to obtain better case management results, better service provision, prevent diseases and promote the health of young people.
Breaking the Silence Surrounding AIDS: A Regional Approach to HIV/AIDS Prevention in Young People (PAHO/Norwegian Agency for Development Cooperation):
The project's mission is to improve countries' capacity to collect better information through the establishment and/or improvement of surveillance systems, and conducting research on youth sexual behaviors and adult barriers that shape the epidemic.
Building on Lessons Learned:
Youth Development and Sexuality to Prevent Pregnancy, HIV/STIs/AIDS in Adolescents from the Central American Region (Guatemala, Honduras, Nicaragua) (PAHO/Swedish International Development Cooperation Agency). This project's mission is to promote health and development of adolescents by supporting countries to develop policy, legislation, and advocacy, implement programs, plans and services, promote social communication, youth participation, develop networks and build capacity.
Joint UN Response to Haitian Youth: Program Avant:
This project will support a five-year program for young people of both sexes (ages 10-24), with an integrated health services approach, and an emphasis on gender equity, beneficiary participation and the use of information technology as a development tool. Program Avant has been designed with the active participation of underprivileged, socially and economically excluded Haitian young people and local stakeholders in the target areas, and responds to the priority needs and interventions they identified.
WHO AIDS Prevention Initiative:
This initiative has three components: health services, environments and epidemiological screening. The project is currently awaiting funds.
Gender and Adolescent Male Health and Development:
Consists of three main interventions: 1. A pilot study on health services for adolescent boys in Rio de Janeiro, Brazil 2. An adolescent health intervention using soccer as a way to promote male development and gender equity. 3. "Project H," which uses a set of five printed materials and a video to promote adolescent male development in areas such as HIV/AIDS, emotional development, violence prevention, fatherhood and sexual and reproductive health.
Health Promotion and Adolescent Development Initiative:
Having clear theories and strategies for adolescent health promotion is a key element for program design, implementation and evaluation. In order to provide better technical support to the countries, we have created the state of the art document "Youth, Choices, and Changes." This document provides a wide range of behavioral change theories and how to better translate them into effective programming, considering the different stages of adolescent development and the social context where youth grow up. As a result of this document and initiative, countries such as Chile have requested training and workshops.
Teen Pregnancy Prevention in Adolescents:
Our goal is to help participating countries reduce teen pregnancy through cost-effective interventions. An example of an effective strategy is to prevent subsequent pregnancies among adolescents. This initiative will be implemented Dominican Republic and other countries in Central America.
Adolescents and Soccer:
Where Masculinity is in Play: The project will work with male preadolescents on the soccer field. The manual "Soccer School: Playing for Health" has been designed for soccer coaches to incorporate adolescent rights and responsibilities during soccer practice.
Strong Families: Family Orientation to Prevent Risk Behavior among Youth:
This project will provide a training module for parents and adolescents in strengthening family ties and preventing risk behaviors.
Promotion of Youth Development and Violence Prevention:
Joint project between PAHO and the German Technical Cooperation (GTZ) that will begin in El Salvador, Nicaragua, Colombia, Peru and Argentina in 2004. The purpose of the project is for youth from these countries to actively participate in youth development and violence prevention, and take part in designing these programs.
