One out of every two persons in India is between the ages of 10 and 29. It is these young men and women who, in the near future, will become parents. And yet, a large majority of them have delusions about themselves, their sexuality and their reproductive health needs. The Sex Education, Counselling, Research, Training and Therapy (SECRT) programme was thus initiated to prepare these youth to become healthy and responsible adults and parents. In 1978, this was a bold and innovative step taken by the Family Planning Association of India (FPAI). Started in Bombay and New Delhi, there are currently nine such programmes throughout India.

In line with its objective to dispel the confusions and misconceptions surrounding human sexuality, marriage and contraception, SECRT introduces sexuality counselling along with family planning services. It also promotes responsible sexual behaviour and family life decisions, particularly among youth.

Box 1 describes SECRT activities which reflect FPAI's main objective -- the promotion of a holistic concept of sexual and reproductive health. Although the programme has married couples as its primary target, special focus is given to youth.

 Staffed by skilled counsellors and consultants, these centres help clients with their sexual and reproductive health problems. As the centres are located in FPAI branches, clients who need clinical services are easily referred to the FPAI clinic.

Training, particularly for developing counselling skills for health professionals, teachers and youth leaders, is an important component of SECRT. The many requests for training by SECRT teams show the effectiveness of the training offered.

Focus on Youth

Research undertaken by SECRT highlights the reality that young people seek information on sexuality from unreliable sources and hence they are misinformed. As such, they are easily influenced and exploited by self-styled, money grabbing "sex specialists". In response to the situation, SECRT launched a programme on Spearhead Youth Health - Leadership Training for Youth in Sexual and Reproductive Health. The programme, consisting of a 3-day training workshop, aims to impart correct information to youth. Content of the training covers information on sexuality, preparing for marriage and planned parenthood, sexual behaviour development, drugs, STD and HIV/AIDS, and counselling and leadership skills for peer group counselling.

Every SECRT centre has had a success story, but Lucknow's experience has been particularly impressive. Its youth programme is almost fully managed by a group of youth who took the initiative to start a youth club to educate fellow youth in sexual and reproductive health.

The Young Inspirers

The scenario with regard to sexuality and reproductive health of youth in Lucknow is no different from other places in India. This situation, coupled with a strong SECRT programme existing in Lucknow, encouraged the FPAI to initiate a youth programme. Thus, in March 1993, 70 male and female students in the age group 16-22 from various colleges in the city of Lucknow participated in a youth sexual and reproductive health workshop. A broad range of topics were included in this workshop. (See Box 2 and Annex 1) The objectives of the workshop were:

1. To impart correct information concerning youth sexuality and reproductive health.
2. To prepare young people as peer counsellors.

This was followed by two workshops where participants engaged in detailed discussion on issues related to youth. Information on the latest development of related issues were also imparted. In addition, participants were trained in the following skills: (1) counselling; (2) communication (3) leadership and management; (4) resource finding and mobilization; and (5) use of audio-visual aids.

Selection

Selection of Young Inspirers was done very carefully. After a rigorous process of interviews with the candidates, their families and friends, 25 potential Inspirers who showed leadership qualities, communication skills and pleasant personalities were selected as club members. At their first meeting in April 1993, the members decided to call themselves the Young Inspirers and that their role would be to promote not only sexual and reproductive health but a holistic concept of healthy living in youth. They would also be responsible for the management, design and implementation of the club and its activities on a voluntary basis.

The Young Inspirers were aware that youth seek advice from their peers instead of consulting their parents or other adults about sexuality and reproductive health. Unfortunately, in most cases, youth are themselves ignorant about the topics or issues hence creating a cycle of misinformation and misconception among youth. Thus, providing youth with an alternative resource outlet becomes another objective of the Young Inspirers.

Incorporating Young People's Perspectives

Being young themselves the Young Inspirers realized that unless youth themselves are involved, efforts to promote healthy living in them will not make a significant impact. Hence, most of the activities they organize take the forms of competitions and exhibitions, allowing active participation of the target group -- young people in the age group 12-30 who are inside or outside the education system, in the urban as well as rural areas. In addition to competitions and exhibitions, depending on the target group, the Young Inspirers also perform role plays, stage drama, and sing songs which they compose. Although the topics of these activities are broad, emphasis is placed on one or two subjects depending on the target groups. For example, the topics on physical and emotional changes, hygiene and nutrition are given emphasis with audiences consisting of the younger age group. Information on STDs, HIV/AIDS and contraception are stressed during activities with college students and out-of-school youth.

Besides organizing and implementing their events, depending on the time availability and capability, the Young Inspirers are also involved in the SECRT activities. In these activities, the involvement of the Young Inspirers range from providing assistance (in the organization of events) and facilitating lectures conducted by the SECRT counsellor. Involvement of this nature allows the Young Inspirers to expand their outreach, enhance their experience as well as gain publicity for their efforts.

Those who have been reached by the Young Inspirers are encouraged to share the information with their families and friends. This strategy, while enabling youth to express their concerns and suggest ways of overcoming their problems, creates a multiplier effect. At the same time, they are given the opportunity to play a useful role in educating the public. Thus, this programme creates a critical mass of youth educating other youth and their families.

Activities

Competition

Competitions take four forms: preparing posters, essay writing, drama/role playing, and debates. While some of these competitions are limited to participating schools, others held in conjunction with public events are open to the public. Prior to holding competitions, the Young Inspirers visit participating schools and colleges and brief students on the topics so that appropriate messages are given out to the public. Judges of these competitions are the Young Inspirers.

Participants are encouraged to interact with the Young Inspirers during these competitions thus giving young people the opportunity to ask questions about various issues. The fact that the information givers are youth themselves creates a comfortable environment for questions related to sexuality, reproductive health and male-female relationships.

Outreach Activities

Upon invitation, the Young Inspirers conduct sessions at schools and colleges. A variety of approaches are used during these sessions depending on the age of the target audience, whether it is a Hindi or English medium school, and the racial make-up of the school. Topics are chosen accordingly and ample time is allocated for discussion. While some students ask questions verbally, others are more comfortable writing their questions and/or comments. These questions are discussed before the end of the session.

For young people not in the education system — rickshaw pullers, mini taxi drivers, youth working at train stations, -- a different approach is employed. The Young Inspirers reach these youth through lectures that rely heavily on pictures. Health, hygiene, STD, HIV/AIDS and drug abuse are the main topics discussed with this group of youth. Plenty of time is allowed for the question and answer session.

Similarly, the Young Inspirers travel to the rural areas to talk to rural youth. Due to the low level of education among young people in the rural areas, the information provided is simplified. Flipcharts with pictures and diagrams are useful in this setting. While interaction is rather slow initially, things begin to pick up after some time. This is because a participatory approach is used and the target audience feels that they are a part of the session rather than being passive listeners. Other approaches used in interacting with rural youth are drama and songs.

Peer Counselling

The Young Inspirers counsel their peers at school and in residential neighbourhoods regularly. Counselling, when required, is also carried out during activities of the Young Inspirers as well as that of the SECRT. In cases where expert help is required or follow-up is necessary, young people are referred to the Counsellor at the Family Planning Association Clinic.

Feedback from Youth Reached

Annex 2 presents feedback from youth who clearly appreciated the information to which they were exposed. While most expressed their appreciation, others took the opportunity to ask questions ranging from menstruation to masturbation to homosexuality. A common request from youth is for their parents as well as other adults to be educated on youth sexual and reproductive health.

Educational Materials

The SECRT, keeping in mind cultural and religious sensitivities, has published pamphlets, booklets, charts, workshop proceedings and audio-visual aids. Although these materials are mostly produced in English, there are materials available in Hindi and three other languages -- Marathi, Gujarati and Gurumukhi. Some materials are also available in braille. Popular among youth is a question and answer booklet Teenagers Ask, the Doctor Answers.The booklet is an attempt to deal with some of the problems commonly encountered by youth.

Management
Members

Currently, there are twelve active members in addition to thirteen others who, due to inability to make full commitment to the club, assist in some of the activities. The other twelve founding members have either moved to other cities to pursue higher education or because their parents moved to another city.

Activity Planning

Activities undertaken by the remaining Young Inspirers may be organized by all members of the group or by a few, depending on the nature and importance of the event. With guidance from the club adviser, the Young Inspirers are responsible for the design of activities, contact with relevant agencies, logistical arrangements, implementation of activities, and follow-up. The trust given to them to manage such activities gives the Young Inspirers a sense of programme ownership, self-respect and confidence.

Meeting

The Young Inspirers meet once a month to discuss future activities, issues, and problems. Meetings are more frequent when the team is preparing for activities. Disagreements, uncommon to the group, are resolved diplomatically.

Adviser

Supporting the Young Inspirers is Nandini Johri, the SECRT counsellor at the FPAI clinic. She provides advice and constructive criticisms without interfering with the decision making process of the Young Inspirers. To the Young Inspirers, she is more than just an adviser. She is a friend. The close relationship she has with her younger friends is a very crucial contributing factor to programme success. Nandini's vast network has facilitated implementation of activities.

Budget

A specific budget for implementation of the activities of the Young Inspirers is not available. The SECRT programme provides a small fund which can only cover stationeries used in the poster competitions, prizes for debate, essay and role-playing/drama competitions and transportation reimbursement for trips to the rural areas. Motivated by the need to provide youth with information necessary for healthy living, the Young Inspirers contribute their ideas and energy voluntarily.

Achievements

Being able to reach youth with information about sexuality and reproductive health within an environment of strong social and cultural sensitivities is an achievement. The Young Inspirers programme, the first of its kind, has served as an experimental project which generates lessons for improving youth sexual and reproductive health programme implementation.

Nine activities were carried out by the Young Inspirers during the period April 1993 and June 1994. They were also actively involved in numerous SECRT activities as facilitators and/or counsellors. (See Annex 3) Approximately 2,225 people, mostly youth, have been reached by the Young Inspirers through these activities.

The principals and teachers of the Young Inspirers have observed a significant improvement in their leadership and organizational abilities. They have gained popularity among their peers who feel free to discuss matters related to youth health including sensitive issues such as sexual and reproductive health with them.

Response from the Community

In general, the community appreciates the efforts undertaken by the Young Inspirers. Interested parents approach teachers to learn more about the programme. They are pleased that their children are given useful education. On the other hand, there are parents who were initially worried about the programme. But after explanation from the teachers, the majority of them are happy with the programme.

Teachers, although convinced that youth need to be informed about sexuality and reproductive health, are often not comfortable in imparting such knowledge. Therefore, they are pleased that the Young Inspirers and the SECRT programme are taking such responsibilities. After the initial outreach by the Young Inspirers, teachers are willing to provide additional information and sometimes counselling to their students. Committed teachers, with support from a large number of parents, hope to institutionalize the programme in the school curriculum. To achieve this goal, parents and teachers need to take up advocacy work. The following steps would be necessary:

1. Generate commitment from the school administrations.
2. Generate support from the community through educating them on the need to meet youth reproductive health needs.
3. Lobby the provincial administration to put pressure on the higher education authority to institutionalize education activities related to youth reproductive health in schools and colleges.

Community leaders in the rural areas learn about the Young Inspirers programme through the SECRT outreach activities and they are supportive of the programme. They often invite the Young Inspirers to hold activities in the rural areas. The methods used by the Young Inspirers in reaching rural youth -- drama, role-play and songs - attract not only the youth but also other members of the community.

Whose Responsibilities

While NGOs could manage small scale projects, these projects are only reaching a limited number of youth, leaving the majority without access to neither information nor services. The challenge therefore is to bring education and services to millions of unreached youth. Such efforts would require resources, both financial and manpower.

The extent of effort required suggest the need for government commitment. However, the government system should consciously adopt an approach where they act only as facilitators rather than direct actors. This would imply that the NGO sector must be extensively involved under the patronage of the government. In other words, the government should champion the cause but allow the NGOs to implement the programmes. NGOs are preferrable in this case because they have a more user responsive attitude than governments and larger agencies which tend to be more provider-oriented.

Arrangements such as the above are not an easy task. Government officials in charge of such programmes would have to work as nurturant leaders. The NGOs, on their part, should have similar abilities so that they could infuse enthusiasm in the Young Inspirers. An understanding of roles is necessary for which effective and purposeful linkages would need to be established.

Comprehensive Coverage

As mentioned earlier, the information given to youth under both the SECRT and the Young Inspirers programmes ranges from nutrition to relationship and from hygiene to sexual and reproductive health. Efforts are made to impart all this information in a short period of time ranging from 1 to 3 days. The questions are:

1. Is the time frame sufficient for the target group to fully understand the information?
2. Is enough time given to dispel the misconception and anxieties youth have?
3. Is ample time given for questions and answers?

Two alternatives can be applied here: (1) to consider prolonging the training time; and (2) to focus on one or two topics per session. The second alternative would require the establishment of a systematic arrangement whereby ongoing sessions can be implemented. The number of days in option 1 and the choice of topics in option 2 will be dependent upon the age, level of education and locality of the target group.

Cost Analysis

The present costs of running the SECRT activities is around 100,000 rupees or approximately US$3,000 per year, covering both personnel and operational costs. As mentioned in the narrative report, the SECRT programme include IEC activities, counselling, provision of services as well as training. Since the purpose of the cost-analysis is to examine the cost of upscaling the Young Inspirers programme, this section will only examine the costs of implementing youth activities for the year 1994. It will then focus on the costs of upscaling the programme.

Innovation as it was Implemented

The Young Inspirers programme functions within the existing infrastructure and facilities provided by the SECRT programme and the costs of activities are met from the SECRT's budget and/or the FPAI headquarters.

Because the Young Inspirers programme has no specific budget, the task of cost analysis is rendered difficult. However, the costs can be approximated by comparing the costs of similar activities carried out by the SECRT programme. Table 1 gives a summary:
 

Activities	Costs per activity (US$)
School outreach  Competition (debate,essay, quiz)  Poster competition  Lecture, group discussion  Training programme	48 16 29    08 65
Total	166

From the above costs, an estimation for upscaling the Young Inspirers programme can be made.

Upscaling the Programme

Upscaling of the Young Inspirers programme is highly desirable and would imply achieving greater coverage by enlarging the various activities and recruitment of more Young Inspirers.

When upscaling the programme, the number of activities will have to be increased. Table 2 gives an estimation of costs for implementation of activities per year.

Table 2

Activities	Costs per activity	No. of activities	No. of youth reached	Costs
School outreach  Competition  + poster  + quiz  + role-play  Training  Awareness camp	48  16  8  10  65  87	22  4  4  4  3  10	1760  100  100  100  60  1000	1056  64  32  40  195  870
Total	234	47	3120	2257

* This is an average figure. The number of youth reached is dependent upon where and when the competitions are held. If these events are held in schools, the number would be smaller than if they were to be undertaken in conjunction with a larger event such as Children's Day or AIDS Awareness Day.

Implementation within the SECRT Facilities

With total costs of US$2,257, the above activities are able to reach an average of 3,120 youth. Therefore, the cost per youth reached is $0.72. Due to the nature of peer network, it is expected that the youth reached through the various activities will in turn reach at least another youth, thus multiplying the number of youth reached to 6,240. If this estimate is right, the cost to reach a youth would be $0.36.

Because the activities are implemented within the existing infrastructure and facilities of the SECRT, there are no capital inputs such as infrastructure or bills (telephone, electricity, etc.). The personnel costs have also been neglected in this estimation. However, a different cost scenario will emerge should the above activities be implemented independently of the SECRT infrastructure and facilities. Since there are numerous SECRT centres or FPAI clinics in many states in India, it is best that the Young Inspirers programme be linked to these facilities. Using this strategy, not only can the low programme budget be maintained, but the facilities and resources available in these centres would contribute to the effectiveness of programme implementation.

Implementation Independent of SECRT Facilities

In FPAI centres where there is not a SECRT counsellor, personnel costs would have to be included in the budget. The costs scenario therefore would be as follows:
 

Activities	US$2,257
Personnel	US$2,903
Total	US$5,160

Adding a budget for personnel brings the cost per youth reached from $0.36 to US$0.80 (the multiplication effect discussed above is assumed in arriving at this cost).

Recruitment of Counsellors

Recruitment of more counsellors is necessary in upscaling the programme. At least another counsellor would be required to efficiently implement the activities listed in Table 2. This would increase the cost per youth reached to $1.30.

Cost of Reaching Youth

The cost to reach a youth through the Young Inspirers programme gives three scenarios as summarized below:

Cost of Reaching a Youth

Modality	Cost per youth (US$)
Current programme	0.36
Programme with personnel costs	0.80
Programme with an additional counsellor	1.30

Strategy, effectiveness and availability of resources are factors to be carefully considered before selecting any of the above models. Even if the first model is very attractive, the question remains whether or not the current programme or strategy can reach a larger group/audience. Although the last model is the most expensive of the three, having an additional counsellor is likely to allow an increase in the number of activities and a greater coverage of youth.

Institutionalization of Programme

A strategy to institutionalize the programme should be considered. Schools and colleges may initially get assistance from the SECRT centres and/or FPAI clinics in training a core group of trained peer counsellors. This strategy is an investment which reduces the costs of reaching in-school youth with reproductive health information. The linkages with the SECRT centres and/or FPAI clinics should be maintained for follow-up services whenever necessary.

Monetary Incentives for the Young Inspirers

Since monetary incentive can be a strong motivation factor for the maintenance of enthusiasm among volunteers, it may be necessary to allocate some budget for token salary or other forms of monetary rewards to the volunteers.

Managerial Requirements

Proper Guidance

Although the programme is managed by the Young Inspirers, the guidance of the counsellor and easy access to her as well as a friendly relationship are strong factors towards smooth programme implementation. The experience suggests that youth are able to and should manage programmes addressing their needs provided that they are given proper training, guidance and supervision.

Creating Values

There is still hesitation on the part of parents, teachers and the elderly to allow youth to be exposed to sexuality education. Such resistance needs to be eliminated. A strategy towards this end would be to offer information to parents and teachers of the need to provide youth with such education. At the same time, society at large also needs to be informed. This is likely to make people feel somewhat more free to discuss topics related to sex and reproductive health. Targeting adults as well as adolescents enhances the likelihood of the creation of a new mindset and eventually an impact.

Target Group

The target groups of the Young Inspirers at present are youth in general. The effectiveness of reaching various groups at short sessions is contentious. Is focusing on specific target groups more effective than the present strategy of reaching diverse groups? For example, will it be more effective for the Young Inspirers to concentrate their efforts on urban youths in schools and colleges? A pilot study and an impact assessment are vehicles through which answers to the above questions can be generated.

Upscaling Issues

Strategy

If the programme is to be upscaled, can the same strategy be applied? While the concept of youth as a focal point for managing and implementing programmes can certainly be applied, maintaining the same strategy for content coverage as well as the rapport between Young Inspirers and the counsellor will require some changes.

If the Young Inspirers are to impart wide ranging topics to fellow youth, they ought to be given a longer training than 1-3 days. While it is easy to maintain rapport with a small group, it may prove difficult with a larger group. One solution is to have more facilitators who are easily accessible.

Impact

A study of the impact of the Young Inspirers programme on behavioural change has not been undertaken. Because of its recent history, the programme has not developed an impact assessment tool. Furthermore, since youth are exposed to various kinds of related information, it is difficult therefore to measure the real impact of the programme. This programme is thus faced with the challenge of developing appropriate evaluation tools.

The lecture was very interesting. It really helped me to sort out my feelings which I couldn't share with other people. You should go to other schools and colleges. There would be many girls like me who would find the lecture helpful.
16 year old girl

The information I have now has cleared many thoughts which confused me. Now I can clear the misconceptions of other girls.
17 year old girl

Our adults are still orthodox minded. They consider reproductive health information as an offence. What should be done to make them understand that we need the information for our own good.
20 year old college student

We teenagers are at loss of what we should do and what we shouldn't. You have helped me a lot in understanding ourselves and how we can solve our problems.
16 year old boy

I liked this teaching because it solved all my doubts about menstruation.
15 year old girl

You should share the information with other students as well as adults. I feel if people like you discuss these matters with adults, naturally all problems will be solved.
18 year old college student

We have learnt how to protect ourselves.
17 year old boy

I would like to suggest that you tell the same to the boys.
17 year old girl

This way of giving lectures facilitate good mental and psychological guidance.
17 year old high school student

1. Role play competition on social awareness through youth participation at a girls' college.

Themes. Sex discrimination, drug addiction, disadvantages of early marriage, female literacy, infertility, disadvantages of having a large family, outside marriage pregnancy, and prostitution.

2. School debate and essay competition.

Themes. (1) Necessity of sex education for today's youth and for making family welfare programme successful. (2) Indian youth is mis-guided for lack of sex education. 200 students (boys and girls) atended the debate. The Young Inspirer team interacted with the students.

Essay. Sex education: Why, When and What. Organized and judged by the Young Inspirers.

3. Poster competition on AIDS awareness (age group 13-16). Young Inspirers gave talks on facts related to HIV/AIDS in the four schools prior to the competition.

4. Dealing with the problems of adolescent students.

Content. What is adolescence?, problems of adolescents, drug abuse, HIV/AIDS, youth health, counselling skills, family welfare with special emphasis on care during adolescence and necessity of sex education

Methodology. Lectures, group discussion, songs, questions and answer session.

Young Inspirers spoke on the above topics.

5. Orientation programme on involvement of taxi drivers (20-35 years) in promoting youth health and family welfare programme. Conducted in collaboration with two other FPAI units.

Content. Immunization, nutrition, hygiene, FP methods, STD, HIV/AIDS, sex education, drug addiction and alcoholism.

Methodology. Quiz followed by explanation of each question's answer; pictures of STD symptoms, charts on AIDS

Special feature. Booklets - Teenager Ask Doctor Answers and FP methods given as prizes.

6. Observation of World AIDS Day: poster competition on AIDS prevention — responsibility of today's youth.

Preparation. Young Inspirers gave information about HIV/AIDS in their respective colleges and motivated their friends to participate in this competition.

Participants, along with their posters, made brief presentations of 3 minutes on the topic.

7. Preparing for marital happiness for boys in college 20 kilometres away from the city.

Content. How to select a partner, what makes a relationship happy, what causes conflict in a relationship, misconceptions related to family planning methods, STD and HIV/AIDS, drug addiction, personality development, and communication skills.

8. Observation of World Environment Day. Participated by male youth in the age group 16-29 years.

Content. Environment, pollution, sexuality, STD and HIV/AIDS, and FP methods.

Methodology. Question & answer session, songs, writing slogans and reading aloud.

9. Observation of World Environment Day. Participated by older women, female youth and children.

Content. Environment, small family norm, health and hygiene.

Methodology. Lecture and discussions.

Activities implemented in collaboration with SECRT where the Young Inspirers assist the SECRT counsellor and/or act as facilitators.

1. Free medical check-up camp for women, youth and children residing at the railway station.

Content. Health & hygiene, STD, HIV/AIDS, problem of drug abuse, and small family norms

Methodology. Physical checkup, distribution of medicines, group discussion and individual counselling.

2. Orientation programme on drug addiction and AIDS awareness for barbers, shopkeepers, drivers, etc.

Content. drug addiction, STD, HIV/AIDS, infertility.

Methodology. Lectures, charts on HIV/AIDS.

3. AIDS prevention in family planning clinics for staff of CFCP and relatives of patients.

Content. HIV/AIDS, ways of transmission, symptoms, prevention,

precautions to be taken by the staff specially ANMs.

Methodology. Lectures and discussions.

4. Reaching the unreached - a training programme for doctors.

Content. How to reach the unreached people?, Reaching them with topics on sexual and reproductive health, STD and HIV/AIDS prevention; Reaching them through role play, songs and group discussion.

Methodology. Discussion and songs.

5. Preparing for marital happiness - training in a rural area for newly married couples.

Content. Achieving happiness in marriage, FP methods, infertility, HIV/AIDS, and childcare.

Methodology. Lectures and discussion.

6. Mothers meet - a meeting of young women, lactating mothers and mother- in-laws.

Content. Rights of women, role of women in making family life healthy and happy, advantages of having a small family, care of the girl child, reproductive health, necessity of sex education especially during adolescents, and STD and HIV/AIDS.

Methodology. Lectures and discussions.

7. Counselling skills, STD, and HIV/AIDS for nurses.

Content. Role of nurses in promoting family welfare programme, nurses as counsellors and counselling skills, STD and HIV/AIDS and FP methods.

Methodology. Lectures, discussions, question and answer session.