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MAZI Articles

To Change the Dance You Must Change the Music: Youth Programmes in Ethiopia Aimed at HIV/AIDS

In this article, the Consortium's Ailish Byrne, senior associate, research and evaluation, and Jim Hunt, senior adviser, describe communication for social change in progress with youth programmes in Ethiopia. These youth dialogue programmes provide young people forums to discuss HIV/AIDS and encourage them take an active role in preventing the spread of the virus. The article also explains how participatory monitoring and evaluate of such programs is essential.

Before I was a member of a Youth Association I had no awareness about HIV/AIDS.  I didn't even believe in the existence of HIV/AIDS.  I actively practiced unsafe sex with many women, due to the influence of alcohol and drug addiction". [After joining] I started participating and following all HIV/AIDS prevention programme activities, specifically the Community Conversations.  I started open discussion with my friends". I began to protect myself and was concerned to know my status". I moved away from drug abuse" and [now] I spend my time doing drama and creative, positive things on HIV/AIDS.  The changes" helped me to be a model to other friends of mine and I developed discussion with my family and other community [members].

Excerpted from a letter from Dawit, a 24-year-old Ethiopian man following a CFSC workshop held in August 2005.

In our work in Ethiopia, we have witnessed and heard many similar stories of significant change in young peoples' lives as a result of their participation in youth clubs and a "Youth Dialogue" focused on HIV/AIDS.  Since 2004 the Consortium has been working with UNICEF and partner organizations such as Ethiopia's HIV/AIDS Prevention and Control Office (HAPCO), to strengthen Communication for Social Change (CFSC) initiatives and develop capacity to monitor and evaluate them in appropriate ways.  This innovative work, at scale, creates exciting and challenging opportunities to enhance the impact of HIV/AIDS initiatives across Ethiopia.  It also constitutes a valuable learning opportunity.

Why Ethiopia?  Why Youth?

In Ethiopia, youth clubs are widely established as social and educational institutions.  They are increasingly finding ways to enter the public dialogue regarding the prevention and treatment of HIV/AIDS.  With a variety of partners, hundreds of clubs are now engaged in a nationwide effort to change the norms governing HIV/AIDS behaviour.  As one of their adult partners puts it: "To change the dance, you must change the music."

Ethiopian statistics speak for themselves.  Ethiopia has a population of 72 million, 44% of whom are under 15 years, with 40% between 10-29 years old.  In the 15-24 year age group, female HIV prevalence is almost twice as high as that of males.  The estimated HIV prevalence rate is 7.3% of adults.  Approximately 2.6 million adults and children have HIV infection, and 750,000 children have already been orphaned by AIDS.  Such figures raise serious questions about how resources for HIV/AIDS initiatives in Ethiopia might be best used.

The Youth Empowerment Through Dialogue programme aims to include more voices and generate as much community dialogue, youth decision-making and tangible action as possible.  It seeks to extend the reach of community voices through the mass media and support community action with appropriate information, service delivery and policy.  UNICEF-trained facilitators now work in five regions, focusing on HIV/AIDS within a broader life-context that includes issues of poverty, jobs"or lack of them-- street children and gender discrimination.  Fundamental CFSC and human rights principles of self-determination, participation and inclusion underlie the initiative.  The work encompasses diverse partnerships at strategic levels, including with youth associations, government, the media, NGOs and schools.

What is the significance of youth clubs?

The clubs and their growing links with partner organizations and the media constitute powerful forums that ensure that young voices are heard and active in setting the agenda relating to individual, media and governmental decisions about HIV/AIDS. 

But we have far to go.  Since the 1980s, Ethiopians"and other people around the world"have witnessed vast amounts of message-driven, top-down HIV/AIDS communication, i.e., information, with minimal or no impact on HIV incidence rates, particularly amongst the youth.  This has led to a scenario of ad-hoc programming in which young people have had no voice or stake in, as well as major gaps, including a neglect of girls.

In this context, many have welcomed initiatives like the Youth Empowerment Through Dialogue Programme, led by UNICEF and HAPCO, which advocates a shift from messages to catalysing and positively changing values, traditions, culture and practice through communication for social change. 

When young people have the opportunity to discuss HIV/AIDS, they consider issues within their own socio-cultural contexts, identify and prioritise their problems, define their capacity and strengths, and mobilize resources for collective gain.  Today, these widespread community discussions are one of the most comprehensive efforts to date to bring CFSC to national scale, and to monitor and evaluate it in a way that is consistent with values at the heart of CFSC, i.e., through a participatory approach (PM&E). 

What has been achieved so far?

Key achievements include more than 400 dialogue sites in five regions, involving more than 20,000 young people engaged in bi-weekly dialogue at youth clubs.  Young people are the main facilitators and initiators of these dialogues, which are giving youth clubs greater purpose and support.

As marginalised groups"including orphans, vulnerable children and girls"gain knowledge about HIV/AIDS and become more active, they are challenging traditional norms and barriers at family and community levels.  Overall, Ethiopian society is witnessing greater youth involvement and voice at strategic levels.  In addition to the benefits of participation itself, noticeable impact includes increased demand for youth-friendly services, greater uptake of Voluntary Counselling and Testing and increased involvement of youth in home-based care initiatives.

The outcomes of dialogue increasingly feed into popular newsletters and radio dramas, many produced by young people.  As Addis Ababa Youth Association noted in January 2005: "Youth have realized their real social, economic and political background" [and] have started to recognize their capacity to solve their own problems/behaviour related to HIV/AIDS". 

As well as growing government support for the initiative, there is increasing demand for technical and financial support for youth to plan and run dialogues themselves.  The Consortium has been closely involved in this partnership and in helping to prepare the ground to develop capacity in Participatory Monitoring and Evaluation (PM&E), at institutional and individual levels.

What is planned for 2006?

Key players intend to expand and improve youth dialogue on HIV/AIDS, to mainstream the voices and concerns of Ethiopian youth in other key sectors, notably child survival and girl's education.  Through this work they hope to bring young people's ideas and action on HIV/AIDS to local, regional, national and international attention through effective communication channels, such as traditional and mass media, in order to influence policy, ensure youth-friendly services and increase the number of young people who know their HIV-status.

In addition, steps are under way to engage the media more effectively to help connect ideas emerging through youth dialogue to decision-makers and help decision-makers listen and respond better. These developments highlight the ongoing challenges of forming and strengthening partnerships between like-minded institutions and individuals aiming to raise the voices of youth"and promote CFSC strategies through meaningful dialogue.

How do we know we are making a difference?

As the youth dialogues continue to evolve and reach a level of maturity, it is increasingly important to gather, document and disseminate evidence of impact. 

Within the context of an ongoing HIV/AIDS crisis, in which young people are at the centre, knowing whether we are truly making an impact is not only for sustainability reasons: It is integral to CFSC approaches.

If done in participatory ways (PM&E), the evaluation process is itself an important channel for capturing and amplifying the voices of beneficiaries and marginalized groups.  What fundamentally distinguishes PM&E is that "success" and "significant change" are determined by intended beneficiaries.  It has practical value, as PM&E processes present opportunities to strengthen trust and stimulate deeper reflection, analysis, sharing and learning between all partners.  Drawing on its international experience, the Consortium is leading on the development of PM&E capacity in relation to CFSC in Ethiopia.  This experience will contribute to the growing international body of experience and knowledge on monitoring and evaluating CFSC.

What are the main challenges?

People involved with this initiative are working to balance a variety of competing goals in financially stretched communities and institutions at a time of considerable political tension.

Youth and partner organizations are driven by the urgency of the disease, the necessity to address it "at scale" at both local and national levels, and by the understanding that they are involved in a long-term process that involves changing more than just individual behaviour. They are pressured to measure short-term success in familiar ways, such as tracking changes in the number of young people who know their HIV status.

However, the long-term benefits of multilevel dialogue relate mainly to intangibles that are not easily measured.  These include evidence that all voices, particularly those of the most affected, have the confidence, information, skills, self-esteem and space to challenge traditional assumptions, roles and behaviours, and societal norms.

Also, processes of working in partnership, developing space for public dialogue in a variety of forums, and collaboration, both within and between organisations, are central and not easily measured.  To demonstrate long-term impact, we are challenged to capture shifting ground, to evaluate process as well as outcome, and to balance and integrate participatory, qualitative and quantitative approaches in ways that participants and institutions learn from. 

We must also satisfy the demands of managers and donors.  At the same time, participants in each CFSC initiative should be able to report their work in ways that managers and donors"and others who are interested"view as valid and valuable.  This remains challenging, despite the ever increasing and widening acknowledgement of the value of participatory approaches, particularly to monitoring and evaluation.  It is particularly demanding since PM&E goes against the grain of mainstream measurement and accountability demands.  Dominant practice and systems are often externally imposed, downplay the perspectives of intended beneficiaries and carry questionable assumptions of validity.

In contrast, PM&E implies a deeper, long-term change process that demands unlearning and relearning at all levels.  The Consortium looks forward to continued collaboration and learning with our partners in Ethiopia and beyond.  Together, we will strive to "change the music" and help young people raise their voices.

For Further Information

The Consortium acknowledges the contributions of all the individuals and organisations involved, especially the partnership with the UK Department for International Development (DfID) and Unicef ESARO, led by Neil Ford and his Unicef Ethiopia colleagues: Afework Ayele, Mirgissa Kaba, Tesfaye Simireta and Richard Mabala.


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