Engaging adolescents in the delivery and measurement of programs: experiences from the Mbare adolescent sexual and reproductive health project in Zimbabwe

BACKGROUND AND OBJECTIVES

Adolescents and Young People (AYP) remain vulnerable and at high risk of poor sexual and reproductive health (SRH) outcomes. Engaging adolescents in the design and delivery of interventions can be effective in enhancing intervention acceptability. Since 2015, MSF's Mbare Adolescent Sexual and Reproductive Health (ASRH) project in Zimbabwe has aimed to improve SRH outcomes among AYP aged 10–24 by implementing community and facility-based services. Community-based information, services and referrals are led by Peer Educators. We consider the project’s practices and experiences to understand what works for meaningful adolescent engagement.

METHODS/STUDY DESIGN

A mixed-methods evaluation was conducted in 2024. This thematic analysis draws from the qualitative findings. Data were collected and analyzed through desk and literature reviews; key informant interviews (n=10); interviews and group discussions with 133 AYP; and external interviews (n=17) with stakeholders. The evaluation prioritized elevating the voices and participation of diverse AYP. Young people were hired and trained as Research Assistants to support data collection and analysis. Validation of findings was also conducted with participants.

RESULTS/EXPECTED RESULTS

Peer Educators revealed the criticality of addressing power dynamics when adolescents are involved in project delivery. While this project remunerates them and provides continuous education and capacity-building opportunities, Peer Educators wanted more involvement in decision making and dignified treatment by other staff. Engaging and recruiting stigmatized and vulnerable groups for the assessment was difficult. Some showed up inebriated, while those who identify as LGBTQI were initially resistant to engage in fear of discrimination. Adolescents in the evaluation team supported interpretation of the findings and the eventual participation of their stigmatized peers.

CONCLUSIONS/DISCUSSION

Participatory engagement of diverse adolescents requires time, persistence, consistency, commitment and a willingness to learn and iterate. We propose a holistic lens to meaningful adolescent engagement in the design, delivery and measurement of programs that is cognizant of intersecting power and sociocultural dynamics.