When the needs of youth to receive information and services related to sexual and reproductive health were recognized internationally in the mid-seventies, the situation of Malaysian youth caught the attention of the Federation of Family Planning Association of Malaysia (FFPAM).  The situation analysis undertaken suggested the need to establish a programme where youth can receive information, advice and guidance on issues pertaining to their health particularly reproductive health. Consequently, the Youth Advisory Centre (YAC) was founded in 1979. It is the first youth centre to tackle the above issue.  Both internal and external forces have presented the YAC with a myriad of obstacles throughout its 15 year history, but the YAC remains one of the most innovative attempts to address youth needs.

Establishment of the YAC

Except for a topic on human physiology and reproduction to which youth are exposed in school, there was no other outlet from which youth could have information about their sexuality and reproductive health.  The lack of family planning and sexual health information available to young women and men gave rise to incalculable problems and unnecessary worries. In response to this unmet need, the FFPAM put forward a project proposal to the International Planned Parenthood Federation (IPPF) for the development of the YAC in the state of Penang.  Penang was chosen as the site for two reasons: (1) the initiative for this programme came from the Penang’s Family Planning Association State Organizer; and (2) this island state is more open to new ideas and innovations. Often utilized as "testing ground", it was the best site to pilot test the YAC. The proposal was approved in 1978 and the YAC was established in 1979 as a component of the Penang FPA.

During the first year, the centre was managed by a full time staff with support from the FPA. In addition, professionals -- psychiatrists, social-workers, medical practitioners, dieticians, etc. -- who are volunteers at the FPA, also provided support to the YAC. With such support, the YAC organized lectures, seminars, advice-sessions, etc. for youth. By the end of the first year, a newsletter Synergy was published and distributed to the increasing number of members and other interested parties such as schools, parent-teacher associations, and factories on a monthly basis. The newsletters incorporate members' views on past events and activities organized by the YAC and detail forthcoming attractions.  Free films were shown to attract youth.  Most of the youth who participated in the initial activities became members.  The first batch of members were surveyed to obtain an understanding of what the most pressing needs of the youth were, and activities were developed on the basis on the survey findings.

The YAC
Objectives

The YAC was established with two objectives:

1. To provide family life education, youth sexual and reproductive health services and other aspects of youth development; and
2. To train youth to become leaders and volunteers.

From the late seventies to the mid-eighties, Malaysia experienced an economic recession and the number of unemployed youth was high. The target group then was out-of-school youth with particular emphasis on younger school-leavers and the unemployed. While employed youth is still a target, the YAC now gives more emphasis on in-school youth.

Activities
The Centre

The YAC is located in a building in the city centre. It includes a library/reading area, an informal social meeting room, and a small administrative area for staff.  While opening hours are between 9.30 a.m - 6.30 p.m on weekdays, additional evening and weekend activities are undertaken occasionally.  Youth visiting the centre have access to the following:

Information. Talks, dialogues, video programmes and exhibitions on family life education are tools for information dissemination.

Library. Literature concerning youth is made available in the library.

Counselling service. This service encompasses sexual health, relationships, employment, etc.

Skills training.  To generate income and increase its membership, the YAC provides skill building services:  computer, math and language skills. Hobby and relaxation attractions are also offered, which include basic cooking, instrument playing, etc.  A minimal fee is charged for participation in these activities.

Referrals. Although contraceptive advice is provided to youth, contraceptives are not provided.  This has been to protect the FPA from adverse publicity and resulting complications.  The FFPAM does not support the provision of contraceptives to unmarried members of the population whatever their age.  Public offence would likely result if YAC responded directly to the need for contraception in this group.  Therefore, youth who require contraceptives or other sexual health services are referred to doctors, who on a voluntary basis, are associated with the YAC.

Outreach Activities

In addition to the activities outlined above at the Centre, the YAC also implements outreach activities.

Youth camps. Started in 1986, the three-day camps focus on providing youth with information on youth health, sexuality, and reproductive health, as well as communication and problem solving skills through the use of role-play and games. Other issues and problems discussed are: drug abuse, smoking, other social problems, the environment and population. Self-development as well as communication and group dynamic skills are also part of the camps' agenda. Participants are sought from the whole youth population of Penang through advertisements in the local press, and in other youth organizations and in schools.

Reaching youth at factories. In their attempts to reach members of the work-force, the YAC offers workshops to women workers working in the industrial centre of Penang. Offered monthly, the 3-day workshop is carried out in the hostels or homes of the workers. Issues addressed include: (1) Women’s health; (2) Nutrition; (3) Budgeting skills; (4) Home security; and (5) Consumer rights. Advice and counselling services on family planning issues are important components of the workshop.  Married women are referred to the FPA clinics for necessary services.

Education activities. Talks and poster competitions are held in conjunction with events such as World AIDS Day.

Recruitment and Training of Members

Over the years the YAC has developed a number of strategies for the  recruitment of its members. Recruitment is largely achieved through ‘word of mouth’ but a variety of avenues have proved fruitful. These include:

• press advertising
• support from school teachers and community leaders
• provision of tuition classes
• social activities -- members are encouraged to bring a friend
• networking with other NGOs
• school based activities

Youth have other responsibilities -- school studies, family obligations -- which take precedence at certain times. When a member or volunteer ‘disappears’, they are still sent the monthly newsletter and are welcomed back at any time with no explanations necessary.

Staff Empowerment

The interaction between the YAC members and other volunteers is informal. When a member expresses a problem or feels unhappy, a brainstorming session or discussion is held. Participation of members and volunteers in decision making is encouraged but not systematically implemented.  There is no formal award system but staff are praised when they do good work. Kind words are used.

Improved Prospects

Career possibilities for the youth volunteers exist because of the exposure they receive. Some of them have been promoted in their work place because of their involvement in the YAC.

Publicity

The YAC courted the local press and radio stations to augment its exposure and to increase the chances of a successful opening. This was to inadvertently lead to the first obstacle to be overcome by the YAC. Although a broad spectrum of youth-centred issues were to be tackled, the more controversial sexuality/family planning components of the programme were over emphasized in the media coverage. The YAC was thus labelled as a form of ‘sex centre’ and much hard work was subsequently directed towards playing down this image in future advertising and articles written about the programme activities.  In overcoming this obstacle, the YAC invited the press to all its activities so that they would understand the real intention of the YAC.  This strategy proved successful and the press is now an ally.

The lesson learned is that one must understand the cultural context and background. New programmes must be introduced gradually. The example of the Chinese press of Penang has shown that a slow introduction to the  programme is more useful. Now there is good understanding with the press and other leaders in the community.

Programme Management
Organizational Structure

In 1987, an increased youth presence in programme implementation was outlined which led to the formation of an Executive Committee (ExCo).  The permanent staff were removed from daily administration of the programme, thus paving the way for the YAC members to manage the programme. Today, one part-time worker from the FPA is available on an informal basis to assist with the  administrative duties.  All volunteers are adequately trained before tasks are assigned to them. The problem solving process include brainstorming and joint decision making through which volunteer participation is encouraged.

Hence, the YAC is managed by youth volunteers.  On the other hand, those presently involved with the YAC are in agreement that a full-time paid staff is required if the YAC is to be more efficient.  Although the Centre still advertises its regular opening hours, it is often unable to meet these obligations given the total reliance upon youth volunteers to run the Centre. Although the future looks promising as the community becomes increasingly aware of the YAC activities and appreciates its roles in meeting the needs of the youth, its future cannot be put solely in the hands of volunteers -- a sense of permanency is required.

The YAC leadership style is a complex mix of authoritative and participative.  Although participation from all members is encouraged this approach has not yet achieved a ‘natural’ status at the YAC. The authoritative style has its roots in the hierarchical and patriarchal Chinese culture.  The present organization of staff at the YAC is detailed below.

Planning

The planning cycle of YAC activities consists of short, medium and long term plans. The short-term planning covers individual year activities. Meetings of the FPA and the YAC members are held to plan activities and map out the annual budget. The medium-term planning covers a three year period. Activities to meet the aims of the YAC are scheduled within this time frame. The planning is done at the FPA level and is submitted to the FFPAM for approval and funding. The long-term planning incorporates the broad objectives of FPA activities. At this stage, the YAC is not represented although their views are presented by the state FPA representatives.

Evaluation

While an informal evaluation is performed by the ExCo every six months, an annual formal evaluation is done by the FPA State Organizer in conjunction with both present and past board members. This committee decides on the necessary programmatic and budgetary changes required to improve programme implementation. Although no in-depth evaluation has been undertaken, a general feeling of success does pervade the members of the YAC. It is felt that most youth reached by the YAC activities did benefit from their participation.

Funding

The YAC has always had one international funding agency. In the past it was the International Planned Parenthood Federation (IPPF), but as of 1987 UNFPA has been the main donor. At the local level, income-generating and fund raising activities are pursued and public donations encouraged. The only assured local financial support received by the YAC is in the form of subsidized rent to the Penang local government. The income-expenditure gap is offset by the local FPA, which receives its funds from the FFPAM.

The aim of the YAC is to become self-sufficient, but so far this has not been achieved. With cuts in funding, the future is somewhat bleak. The most significant impact of reduced funding has been felt in the decreased staffing of the YAC, which has led to serious problems in the day-to-day running of the centre.

The planning and funding process involved in the various YAC activities works to prevent the immediate implementation of new ideas and strategies, however small. The YAC has very limited opportunities for implementing their ideas. Programmes are proposed but ExCo members change annually or bi-annually, often before any of their programme ideas are authorized and funding support is mobilized. The bureaucracy attached to the funding system means no money is available for staff to implement their ideas. No ‘miscellaneous’ funds exist for ExCo members and other volunteers to utilize for immediate needs. If an impromptu invitation arrives for giving a lecture away from the YAC, volunteers are left to pay their own transportation costs, etc. This is one of the most often cited complaints of the YAC volunteers.

Achievements

• Space for youth. The YAC provides youth with a space for obtaining  information, education, and skills. It also gives them the opportunity for self-development.
• Press support. In the early stages, the press were neglected resulting in the YAC receiving bad publicity as the press believed that the YAC was a disguised sex-centre for youth. The problem was rectified and today the press is paramount in sensitizing the general public on issues related to youth health, including sexual health.  Local people come to know of the YAC activities through the advertisements they carry.
• Referrals. The YAC receives referrals from a wide audience. New members often cite friends and relatives as the reason behind their individual contact with the YAC.
• Model. Based on the YAC programme models, other youth organizations have incorporated aspects of its Family Life Education into their activities.

Community Support

The YAC has succeeded in establishing overall good contact with the  Chinese, but not the Malay community. Chinese society is very much based on an "old boys network", and many respected community leaders have been active in the YAC activities, thus giving the YAC respectability. The YAC has also gained support from Buddhist religious leaders.

Looking Ahead

After being in existence for 15 years, the YAC still faces many challenges. It needs to strengthen its human resources by training volunteers more professionally, enhance flexibility in its operations, ensure more continuity in its formal leadership and establish closer relationships with other organizations.
The YAC is looking to establish stronger bonds with schools with the aim to attract younger members and create an interest in its programmes and activities at an earlier age.  Building on its record, the YAC could reach a larger number of schools covering 10-15 year olds, train resource persons for FLE and establish a telephone hot line services.  Thus, the YAC could increase not only its reach but also institutionalize the reproductive and sexual health education programmes in schools.

Financial sustainability is the major concern and the pressure to  generate its funding from local sources has increased.  This has led to financial uncertainty which needs to be addressed. A viable and coherent strategy to generate resources from the community to meet growing community needs is the YAC’s major challenge.

Cost Analysis

It is difficult to analyze the cost of the programme as (1) diverse activities are carried out; (2) the activities are supported by the infrastructure of FPA; and (3) there is no information on how many persons are reached through the youth peer network. Despite these difficulties, some tentative estimates have been made for estimating the cost of reaching a youth.

Current Programme

The programme reaches youth through three ways: talks, training and exhibitions.  The table below gives the cost for 1993.
 

Total cost	RM 30,480
Total number of youth reached	8,280
Talks	3,110
Training	615
Exhibition	4,555
Total reached	8,280

The cost per youth reached is RM3.68 or US$1.50. Based on this cost, it can be assumed that if each youth directly reached through the programme would in turn reach an additional youth, then the cost per youth reached would be halved to US$0.75.

Upscaling the Programme

It is recognized by the programme managers that the YAC can maximize its reach to youth by:

1. Establishing a telephone hot line service;
2. Utilizing the peer network more actively by providing small but flexible funds to the volunteers; and
3. Using printed materials more extensively.

The impact of the above changes is not clear.  Therefore, a demonstration package would have to be developed and implemented. Utilizing the current estimates, it would cost around US$365,000 (population 19.5 million x birth rate 25/1000 x US$0.75 per youth) to reach the youth in Malaysia through such a programme.

It should be reiterated, however, that a careful cost analysis would be needed before definitive cost estimates can be arrived at. A programme package  which maximizes the reach may also have to be tested.

Managerial Requirements
Institutionalization

For successful institutionalization, the programme needs to build four types of linkages: (1) enabling linkages which provide resources for it to function; (2) functional linkages which provide input and utilize output from the programme; (3) normative linkages with those sections of the community which set the norms and values in the society related to programme activities; and (4) linkages with the clients of the programme.

Enabling Linkages

All contacts with international funding agencies is coordinated through the FFPAM. The YAC proposes activities to the state FPA which in turn proposes them to the FFPAM.

Local community funding is generated on an ad hoc basis through fund raising activities.  As mentioned earlier, the only funding from the local government is subsidized rent in the community owned house where most of Penang youth organizations are located.

Functional Linkages

The functional linkages of the YAC with other organizations in the community are very informal, mostly through personal contacts with respected community members, heads of schools etc. The Chinese society is built on an "old boys association" where their opinions are respected. The YAC also has supporters among religious and community leaders. With such contacts, the YAC is able to facilitate programme development and implementation.

Parents-teachers organizations are also contacted through personal  contacts. Social functions in the community are used as occasions to maintain these contacts and to create new ones. The contacts with the women’s section of FPA is through the formal mechanisms of the FPA but the YAC members do not have any significant involvement with that section.

The FPA clinic cannot provide treatment of STDs and/or address unwanted pregnancies among young people as that might harm other programmes of the clinic. Therefore, the FPA clinic is utilized as a base for knowledge only. So when a young person requires clinical or counselling services, the YAC refers him/her to volunteer doctors for help.

Normative Linkages

The YAC has been establishing normative linkages by creating awareness among the leading community members about its activities. It has been able to establish good contacts with the Chinese community. Many respected community leaders were active in the YAC when they were young which gives the YAC credibility. For example, Dr Yee is a very respected citizen in  Georgetown.  When he comments on articles related to youth and sexuality, his opinion is  respected.

The press is always invited to the YAC activities for two purposes. First, it informs the press personnel about the YAC and its activities. Second, information on the activities of the YAC spreads to the community through press reports.

Client Linkages

The potential clients of the YAC come to know about the programme via the press and word of mouth. The YAC is conscious that once a client is helped, he/she will spread the word. Therefore, quality of its activities is important.

The needs of the client are assessed through contacts with young people as well as through published reports.

Lessons

The YAC is an example of a small programme covering a relatively small part of the population.  However,  several  lessons  can  be  learned  from its  experiences.

Creating Social Acceptability

It is important to understand the cultural context and to create acceptability for youth activities within that context. The early problems of the YAC with the press are a case in point. Therefore, it is important that youth programmes establish normative linkages with the community and evolve their programmes gradually.

Penang offered a more hospitable cultural context for the YAC activities. It was the first British settlement in the region and trade and tourism have given Penang an exposure to other cultures for a long time. The long history of accepting ‘new’ things has created a society where it is possible to start innovative activities.

Involving Youth in Planning and Implementation

Working with youth and using them as channels for information dissemination in the peer group require certain organizational preparations:

• Youth programme should be formulated in broad terms in order to allow flexibility for adaptation. Some budgetary flexibility is also essential.
• The time cycle from suggestion to decision and to action needs to be short. Therefore,  the  decision  making  structure  needs  to  be made  less  hierarchical.
• In order to give youth appropriate power within the organization and the satisfaction of seeing the results of their activities, the planning cycle must be shortened. In the YAC, sometimes it takes up to three years for ideas to be implemented.
• Proper guidance is essential. Young persons have enthusiasm but do not necessarily have the necessary patience or skills. Therefore, it is important for a programme manager to provide guidance to youth while encouraging them.
• In programmes where there is high turnover among the youth, it is important to have a base for continuity. One full-time staff for running day to day administrative tasks as well as for providing moral support to the young is needed.

Leadership Style

The chances of success of a youth programme are greatly enhanced if there is a father/mother figure in the programme. In the YAC, one person has been the informal leader for years. This informal leader plays a father/mother role, someone that the young can turn to for advice.  But such a leader should not unduly interfere.

The elected YAC chairman plays an important role as a formal leader. Therefore, investment of time and effort in training the YAC chairman for performing her/his role well is crucial.

Issues
Sustainability

YAC has a built-in problem regarding continuity. High turnover of youth volunteers and weak financial resources are  two of the most significant constraints in sustaining the programme.

Paid full-time staff is a way to limit the impact of volunteer turnover on the YAC activities. A secure financial base will give the youth a chance to concentrate on the programme. In the YAC, more time is often spent on fund raising than on programme activities.

The ideal situation is when enabling linkages are sufficiently strong, and when the community is willing to support the youth programme.

Impact
Due to the lack of impact indicators, it is difficult to evaluate youth programmes. Therefore, specific impact indicators must be thought of at the planning stage of the programme.

Beyond directly reaching youth, what has the YAC achieved?  First, the  Chinese press has become sensitized to youth needs and issues. Second, there is a dialogue within the community about sensitive topics related to youth sexuality and reproductive health needs. Third, due to the influence of the YAC, other organizations in Penang have included some components of family life education in their activities. Fourth, there is some impact on other organizations in that they refer youth to the YAC.

It is almost impossible for youth/adolescent sexual and reproductive health programmes to be fully self-reliant and they will most likely continue to rely on donor/community support. Setting impact indicators and using effective methods for showing result can gain continued donor support. Youth programmes, therefore, should set realistic and measurable goals for both direct and indirect impact.