Evaluation of the African Youth Alliance program in Tanzania

102 Pages·2008·1.29 MB·English

E
VALUATION OF THE
A Y A P
FRICAN OUTH LLIANCE ROGRAM
T
IN ANZANIA
Impact on
Sexual and Reproductive Health Behavior
among Young People
2007
© 2007, JSI Research & Training Institute, Inc.
This report is made possible by the generous support of the Bill & Melinda
Gates Foundation. The opinions expressed in this publication do not neces-
sarily reflect the views of the Bill & Melinda Gates Foundation.
JSI Research & Training Institute, Inc.
1616 N. Fort Myer Drive
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Phone: [phone]
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[email protected]
E
VALUATION OF THE
A Y A P
FRICAN OUTH LLIANCE ROGRAM
T :
IN ANZANIA
Impact on
Sexual and Reproductive Health Behavior
among Young People
2007

Acknowledgments
This evaluation of the African Youth Alliance (AYA) program in Tanzania was a col-
laborative activity funded by the Bill & Melinda Gates Foundation through a con-
tract with JSI Research and Training Institute, Inc. The evaluation benefi ted from
the support of many organizations and individuals. First and foremost, JSI would
like to thank the young people and heads of households in Tanzania who agreed to
participate in the evaluation. Their willingness to respond to important questions has
increased understanding of the complexity of adolescent sexual and reproductive
health (ASRH) programming and strategies for reaching young people with important
services and resources. It is our hope that the fi ndings of this evaluation will contrib-
ute to better ASRH programming and to increased recognition of the importance of
meeting sexual and reproductive health needs among all youth.
The Institute of Resource Assessment (IRA) of the University of Dar es Salaam car-
ried out the fi eldwork and data entry for this evaluation. JSI greatly appreciates the
IRA’s role in providing technical and managerial oversight for the evaluation, particu-
larly the contributions of Dr. Ndalahwa F. Madulu (demographer and team leader),
Dr. Godwin Naimani (statistician and sampling expert), Ms. Hilda Kiwasila (public
health and gender expert), Dr. Claude G. Mung’ong’o (sociologist), and Mr. C. Florian
S. Silangwa (demographer). Sincere thanks also go to the dedicated and hard-working
team of 40 young Tanzanian men and women who served as research assistants, data
collectors, and supervisors (see appendix A).
This evaluation would not have been possible without the support of AYA staff mem-
bers and AYA partners and their willingness to share information about program
strategies, interventions, and experiences. Special thanks go to AYA program offi cers
and other partners in the United States and Tanzania, including Lisa Mueller from the
Program for Appropriate Technology in Health, Gwyn Ainsworth and Carolyn Boyce
from Pathfi nder International, Ugochi Daniels and Nicola Jones from the United Na-
tions Population Fund, former AYA/Tanzania Coordinator Halima Shariff, and the
many AYA implementing partners who provided input on program activities.1 Their
insights on program implementation were invaluable for information about sampling
1. Current and former program offi cers from implementing partners include Ester Lugana, The Fam-
ily Planning Association of Tanzania (UMATI) Arusha; Asha Mruma, director, CHAWAKUA; Robert
Kalinga, Marie Stopes Global Partnership–Tanzania (Arusha); Ms. Razia, area manager, UMATI; and
Edna Legamo, center coordinator, UMATI.
Evaluation of the African Youth Alliance Program in Tanzania v
strategies, exposure measures, interpretation of fi ndings, and many other aspects of
the evaluation.
JSI would also like to thank the many Tanzanian government offi cials and community
leaders who responded to questions on ASRH, gave approval for the fi eldwork, and
helped identify households at the district and subdistrict levels. We are particularly
grateful for the support from the municipal authorities and ward leaders during the
exercise. The help from Mtaa and subvillage leaders allowed the evaluation team to
reach all households, including places that are diffi cult to reach.
In addition, thanks are offered to the AYA technical advisory committee on moni-
toring and evaluation, which advised the team on evaluation design and analysis. In
particular, JSI would like to thank Dr. Robert Magnani and Dr. Doug Kirby, who
reviewed various drafts of the evaluation proposal and report and who offered valu-
able insights on the methodology.
Finally, JSI would like to thank the Bill & Melinda Gates Foundation for providing
the funding for this evaluation, as well as guidance and support. In particular, the JSI
team wishes to thank Jacqueline Darroch and Susan Rich for their technical input at
various stages of the evaluation.
Tanzania Evaluation Team Members
JSI Research & Training Institute Institute of Resource Assessment (IRA)
Ali Karim Ndalahwa F. Madulu
Stephanie Mullen Godwin Naimani
Jessica Posner Hilda Kiwasila
Disha Ali Claude G. Mung’ong’o
Tim Williams C. Florian S. Silangwa
Anne LaFond
vi Evaluation of the African Youth Alliance Program in Tanzania
Table of Contents
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
List of Abbreviations and Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Country Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Appendixes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Evaluation of the African Youth Alliance Program in Tanzania vii

List of Abbreviations and Acronyms
AIDS acquired immune defi ciency syndrome
AMREF African Medical and Research Foundation
ASRH adolescent sexual and reproductive health
ATT average effect of treatment on the treated
AYA African Youth Alliance
BCC behavior change communication
CHAWAKUA Women’s Organization to Fight AIDS in Arusha
DHS Demographic and Health Survey
EA enumeration area
HIV human immunodefi ciency virus
IDC Infectious Diseases Centre
IMR infant mortality rate
IP implementing partner
IRA Institute of Resource Assessment, University of Dar es Salaam
IV instrumental variable
JSI JSI Research and Training Institute, Inc.
LPS life-planning skills
NBS National Bureau of Statistics
NGO nongovernmental organization
OLS ordinary least square
PATH Program for Appropriate Technology in Health
PRB Population Reference Bureau
PSM propensity score matching
SPSS formerly Statistical Package for the Social Sciences
STI sexually transmitted infection
TACAIDS Tanzania Commission on AIDS
TDHS Tanzanian Demographic and Health Survey
TFR total fertility rate
THIS Tanzania HIV/AIDS Indicator Survey
UMATI The Family Planning Association of Tanzania
UNFPA United Nations Population Fund
URT United Republic of Tanzania
WHO World Health Organization
YFS youth-friendly services
Evaluation of the African Youth Alliance Program in Tanzania ix