Federal Democratic Republic of Ethiopia

Ministry of Health

Adolescent Reproductive Health Extension

Package

September 2003
Addis Ababa
 Table of Contents

Title Page

1. Introduction.................................................................................................1
2. objectives....................................................................................................3
2.1 General objective ...............................................................................3
2.2 Specific Objective ..............................................................................3
3. Strategies ...................................................................................................3
4. Activities: ....................................................................................................5
4.1 Program Orientation...........................................................................5
4.2 Data Collection and Management ......................................................5
4.3 Provision Orientation..........................................................................5
4.3.1. The Importance of Adolescent Reproductive Health .............5
4.3.2. Provision of Education on Development Changes in
Adolescence ..........................................................................6
4.3.3. Education on the Adolescent Reproductive Health Related
Problems ...............................................................................8
4.3.3.1. HIV/AIDS and other sexually transmitted Diseases..8
4.3.3.2. Female Genital Mutilation.........................................9
4.3.3.3. High Risk Abortion..................................................10
4.3.3.4. Early Age Marriage.................................................12
4.3.4. Adolescent Reproductive Health Related Problems ............14
4.3.4.1. Alcoholism ..............................................................14
4.3.4.2. Highly Addictive Substances and Narcotics ...........14
4.3.5. Social Problems...................................................................16
4.4. Provision of Adolescent Reproductive Health Services.................19
4.4.1. Establishment of Adolescent Reproductive Health Center ..19
4.4.2. Establishment and Organization of Youth Recreational
facilities................................................................................19
4.4.3. Provision of Family Planning and Reproductive Health
Services...............................................................................19
5. Expected Outputs /Results .....................................................................20
6. Communication Methods to Disseminator Health Messages..................21
7. Information Massage, Maintaining and Revelation Mechanisms. ..........23
1. Introduction

Adolescence is a transitional period when a person is young and

dependent. At the same time, the brain is being matured and there is
rapid physical development. It is also an important period to obtain the
necessary knowledge and skills to prepare one-self to engage in social
affairs and activities. Hence, it is an age-group under going through
continuous development process and requires a special attention and
sustained support.

Adolescence is a period of high developmental changes in physical,

mental and social conditions. In this period the adolescent youth fails to
control his emotions, listen to parents’ advice and begins to indulge
himself in unhealthy behavioral activities. The youth is categorized in
three age-groups 10 to 14 years old as teenage 15 to 19 year as early
adolescent and 20 to 24 years as post-adolescent. In general, the age-
group from 10 to 19 years is classified as adolescent. The problems of
the adolescent arise from lack of understanding and proper response to
the changes that occur during development, due to emotional behavior,
peer pressure and the lack of experience of the prevailing social system
and its interactions. In order to be prepared and respond to problems
related to adolescence it is necessary to acquire a comprehensive
knowledge concerning adolescence. Therefore, the adolescent should
learn about human reproductive system; reproductive organs and their
function, problems related to adolescence and in particular about an
appropriate family responsibility. This undertaking should prepare the
adolescent to feel responsible; to aspire and/or anticipate for a better
future; to overcome problems and hurdles of life and eventually emerge
equipped with the necessary knowledge and skills and physically strong
and fit. The adolescent should be able to differentiate useful and harmful

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behavior and practices and feel responsible to protect others from danger.
In this respect, families and communities have important roles to play. In
order for the adolescent to become effective head of family, the
adolescent should know about the definition of the family and its historical
development and relationships.

Adolescence is an age-group that undergoes through physical, emotional,

mental and social changes that place its life at high risk. Consequently,
most of the youth are exposed to casual sexual practices; unwanted
pregnancy, child bearing at early age, high risk abortion, HIV/AIDS and
other sexually transmitted diseases, rape unemployment, poverty and
criminal acts. In addition, the adolescents don’t receive adequate
information and services on reproductive health. Even if services are
available they don’t utilize them. This situation has made the problems
associated with adolescent reproductive health serious and complex.

The adolescent reproductive health programme is one of the priority

components of the Health Extension Package. The programme is
designed to focus on the production of healthy adolescents that will
effectively succeed the present generation. However, the adolescents
should form associations and create forums to discuss and resolve issues
and problems related to adolescent reproductive health. This way, the
adolescents will be able to induce behavioral changes and thereby
prevent itself from diseases and related risks. Hence, the adolescent
reproduction health extension package has been developed for
implementation in rural Ethiopia.

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2. Objective:

2.1 General objective:

Adolescent reproductive health programme in general and the
extension package in particular aims at producing healthy
adolescent population that is physically, mentally and socially well-
developed.

2.2 Specific objectives:

2.2.1 provide adequate information and education to reduce and/or
gradually eliminate traditional harmful practices that cause
adolescent reproduction health related problems.
2.2.2 Assist adolescents to protect themselves from HIV/AIDS and
other sexually transmitted diseases.
2.2.3 Protect adolescent young persons from unwanted pregnancy,
high risk abortion, and other reproductive health related
problems.
2.2.4 Assist the adolescent young persons to protect themselves and
their families from using addictive plants, narcotics and alcohol.
2.2.5 Guide and alert/motivate adolescent to utilize available family
planning and reproductive health services.

3. Strategies:
3.1 Conducting survey (base line study)
The health extension workers should collect baseline information
before starting programme implementation. Such a baseline data
will help during evaluation to indicate the progress of the
implementation of the adolescent reproductive health programme.

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3.2 Creating enabling conditions for the adolescents to receive health
education and services on HIV/AIDS and other sexually transmitted
diseases.
3.3 Providing adequate information to protect adolescents from casual
sex, unwanted pregnancy, early child bearing age, and high risk
abortion.
3.4 Educating adolescents on traditional harmful practices and protect
them from incidents of rape, early age marriage and female genital
mutilation.
3.5 Creating enabling environment for adolescents to receive adequate
information and education, to develop skills and improve their living
styles and eventually become responsible nationals.
3.6 Providing adequate information and education to adolescents to
protect themselves from addictive plants, alcoholic drinks and
narcotics.
3.7 Establishing forums to discuss issues and problems related to
adolescent reproductive health.
3.8 Expanding adolescent reproductive health programmes in schools.
3.9 Training of Trainers (TOT): Selecting and training volunteer house-
wives who have completed education and/or are dropouts from
school. These volunteers are residents of the Kebele and should
be able to coordinate the community members. The volunteer
house-wives will be aids to the health extension workers and will
have the task of educating their neighbors.
3.10 Youth Day
Organizing and initiating the youth groups engaged in the activities
of reproductive health to develop and present short dialogues,
dramas and writings under the slogan youth to youth and present
them for the Kebele residents. In addition, celebrity persons
should be invited for discussions. The youth should provide
sustained education on adolescent reproductive health and should

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 commit itself to make the day a special occasion to strive to bring
behavioral changes.

4. Activities of the Health Extension Worker:

Keep record of the important health problems of the youth in the

community and provide information and education, on adolescent
reproductive health programmes.

4.1 Programme orientation:

Orient the Female authorities, religious leaders, communities,
government organization and NGOs in the Kebele on the
importance of adolescent reproductive health problems.
4.2 Data collection and management:
Collect and compile information, by going house to house, from the
youth between the age-groups of 10-24 years on age, level of
education, sex and marital status.
4.3 Provision of health education on adolescent reproductive health:
4.3.1 The importance of adolescent reproductive health: Adolescent
reproductive health intends to cover and focus on the youth
population based on the following rationale.
 The youth age-groups in Ethiopia is 25% of the total
population and out of this, those above 24 years old are
married.
 The majority of the youth population don’t receive adequate
information and services on reproductive health, HIV/AIDS
and other sexually transmitted diseases.
 The majority of female youth population in cities, towns and
rural areas are exposed to sex harassment and rape,
unemployment, poverty, crime acts, casual sex, unwanted
pregnancy, early child bearing and high risk abortion.

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  Of those people that live with HIV/AIDS, more than 50% are
below the age of 25 years.
 It is necessary to create enabling conditions for the young
generation which is the potential guardian of the Nation to
protect itself from casual sex practices, early marriage, early
child bearing etc.
 Adolescence is the period devoted to learning, mental
development and broadening of vision and thoughts and the
beginning of obtaining practical experience on social affairs
and social interactions. In general, the period lays down the
foundation of life and life style.
 It is a period when the young is unable to control his/her
emotions and activities which in most cases violate the
norms of and standards of decent life style of families and
communities.
 Adolescence is also a period during which the young
females are exposed to commercial sex, and in general, the
young leaves school due to different reasons, use addictive
substances such as alcohol, some plants and drugs , and
break away from families due to misbehavior.
 It essential to create conducive environment to provide
adequate information, skills, better living and life style etc.
to the young population to enable it to effectively take over in
the future, national responsibilities from the incumbent
generation.

4.3.2 Provision of education on the development changes during

adolescence:-
Development changes occur in any young person but the age at
which the manifestations of the changes show are different from
one young person to the other. In general, gradual

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 development changes occur after at the age of eight years.
Adolescence is the period during which sex organs develop and
mature and are ready for sexual intercourse. During this
particular stage of physical development changes evolve and
trigger disturbances and strongly motivating feelings in the
young. In as much as the changes make the young feel proud
and happy, there are also feelings and conditions that confuse
and frustrate him. This particular period is important for families
and communities in general, to pay attention to the behavioral
conditions of the youth. They should provide advice to the
youth and make all possible interventions to influence them to
carefully select their mates. As it is inevitable for the youth to
go through such a process, the youth is often observed holding
discussions, searching for information and some times raising
questions that don’t have easy answers.

Changes developing in young females:

• The breast starts to develop and grow, feeling of breast pain;
growth and sticking out of the nipples;
• Growth of hair in the armpit and pubic (around the genitals).
• The initiation of menstrual period;
• Broadening of the pelvic;
• Change in the amount and smell of body sweat;
• Increased eagerness to know more about sex; and
• Developing keen Interest and/or falling in love with opposite sex.

Changes developing in young males:-

• Change of voice;
• Building and broadening of shoulder and chest;
• Growing beard; starting to grow hair in the armpit, pubic and
perhaps in the chest;

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 • Development of male genitals and testicles;
• Starting to release sperm;
• Change in the amount and smell of body sweat;
• Increased eagerness to know more about sex;
• Developing keen interest and/or falling in love with opposite sex;
and
• Releasing sperm for the first time in bed during sleep.

4.3.3. Education on adolescent reproductive health related

problems:

First of all, it is important to make a rapid assessment to know

about the prevailing adolescent reproductive health problems by
type. Then discuss the problems with the communities to draw
common interventions and solutions. The rural youth are mostly
exposed to various health problems, because they often travel to
market places in near by small towns. Here, they are easily caught
by alcoholic drinks and commercial sex workers and it is likely that
they are exposed to reproductive health related problems. The
anticipated adolescent reproductive health related and other social
problems are presented below.

4.3.3.1 HIV/AIDS and other sexually transmitted diseases:

The major sexually transmitted disease are HIV/AIDS, syphilis,

chancroid, gonorrhea, etc, The prevention and control measures for
both HIV/AIDS and other sexually transmitted diseases are the same.
Therefore preventing and controlling sexually transmitted diseases
means without doubt preventing and controlling HIV/AIDS.
• HIV/AIDS prevention and control measures:-

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 • Abstain /refrain from sexual intercourse before and outside
marriage;
• Sexual intercourse between two HIV/AIDS laboratory test free
sexual partners must be based on absolute trust and sustained one
to one relationship.
• Use condom properly, if for any reason or reasons sexual
intercourse before and outside marriage is needed.
• Don’t ever share cutting and sharp instruments for use. At home
separate items used by adults and children such blade, needles,
traditional pliers etc;
• Advice and follow up patients sick from sexually transmitted
diseases other than HIV/AIDS to go to nearest health facility;
• Don’t use the services of legally uncertified health facilities;
• Refrain from harmful traditional practices that expose to HIV/AIDS
and other sexually transmitted diseases;
• Keep clean the areas around genitals;
• Advise and motivate suspected young individuals to go to health
facilities and use HIV/AIDS counseling services.; and
• Provide support and care with affection to people living with
HIV/AIDS and victims at family and community levels.

4.3.3.2. Female genital mutilation.

Female genital mutilation is one of the harmful traditional practices

that cause problems of adolescent reproduction health. It is widely
practiced in 28 African countries including Ethiopia. Mutilation of
female genitals causes immediate and delayed health problems in
young females. The immediate health problems of the young
females include bleeding, unconsciousness, septicemia, problem of
urination and sometimes death. Among the problems that come
late are infertility, scar, fistula, delay in labour, infant and maternal

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 mortality and HIVI/AIDS. In addition to the violation of human rights
related to females, it seriously affects the happy and peaceful
marriage of such victims. Furthermore, the number of deaths of
mothers and infants is increased.

It is essential to prevent and eventually eliminate the harmful

traditional practices of mutilation of female genitals. The choice of
intervention would be to provide sustained and adequate
information on reproductive health. This could be realized through
the coordination and support of the Kebele management, religious
leaders, schools, women and youth associations, other government
organizations, NGOs and the communities at large.

4.3.3.3. High risk abortion

The youth engages in casual sex in the absence of adequate

knowledge on sex and reproductive health and often without
contraceptive methods. The consequences of such traditional
practices is that the young females are exposed to illegal and high
risk abortion resulting in illness, disability and death.

Main reasons for abortion:-

• Lack of appropriate information on sex and reproductive health;
• The non-existence of adequate services for abortion;
• The victims don’t have access to adequate financial and other supports;
and
• Communities don’t effectively utilize available family planning services to
prevent and control abortion.

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Activities to prevent and control high risk abortion:-

The youth should be provided with adequate and reliable information on

sex, reproductive health and appropriate reproductive health services.
The youth should be prepared and equipped with the necessary
information, knowledge and skills to protect themselves from high risk
casual sex intercourse and to improve its negotiation capacity. The youth
should receive appropriate information and education on family life, the
development of reproductive organs, the relationship of opposite sexes,
unwanted pregnancy, illegal abortion, HIV/AIDS and other sexually
transmitted diseases, appropriate family responsibility, marriage, the
importance of family planning services etc. The specific activities are the
following.
• Increase awareness of the youth on sex abstinence and healthy
behaviors that reduce reproductive health related problems.
• Because of casual sexual motive, young females are frequently
subjected to rape and unwanted pregnancy. Therefore, they should be
educated and convinced strongly to commit themselves to utilize
contraceptive methods to prevent unwanted pregnancy.
• Human beings go through the continuous process of development
starting from conception to birth and after birth to death. With the
progress of age there will be physical, mental and social development.
Both the male and female individually think of being a husband and a
wife and eventually a farther and a mother. This is why the youth
should effectively learn about family life and sex. In addition, the youth
should receive comprehensive support to enable it to assess the
different processes and changes of development and overcome the
risk.
• Educate the youth to abstain /refrain from sex before marriage.
• Educate the youth to stick on one to one sex partnership as an
important option.

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 • In case of unforeseen circumstances use condom.
• Conduct frank discussions on sex with friends and family.
• Provide continuous education to communities to give moral, and
material support and care to HIV/AIDS patients and victims if possible
the support should include to communities working on their farms,
• Provide adequate information and education on the complex
consequences of abortion on the female youth, so that the
communities will support the victims physically, mentally and socially.
• Motivate and mobilize the youth in the farmers association to establish
health clubs that promote sex abstinence, healthy reproduction and
healthy sex behavior among the youth, in addition, the health clubs
should be supported in their efforts to disseminate information and
create healthy environment.

4.3.3.4. Early-age marriage

Marriage in Ethiopia is often concluded according to established traditional

practices and norms in different nations and nationalities. In the rural
areas, however, it is common practice by families to marry their young
girls at an early age. Early-age marriage is preferred by families for the
following reasons. First, families prefer to get their daughters married
while alive and or before they get old. Second, the marriage is
accomplished with wealthy family in order to improve the living conditions
of the bride’s family. Third, to establish better relationship and tie between
two families. Fourth, to prove that the bride is virgin, a litmus test that
reassure that the bride is from a decent family. Fifth, to ensure that the
bride is married at the right and socially accepted age limit.

What are the consequences of early age marriage on young females:- .

• Miss education opportunity and /or become out of school: young females
miss the opportunity to go to school if she got married at an early age.

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 The next episode is that the married girls often get pregnant. As the girls
didn't get adequate education, their fate is indeed decided by others such
as her parents, her husband and his parents and relatives etc.

• Working /serving others:

Girls work at home for their parents and brothers. Even though, girls are
married at an early age and are too young, they continue to work for their
husband and his family ( the parents etc). At the same time their fate is
decided by others. This state of affairs becomes an impediment to develop
and acquire knowledge and skills to decide on their fate and related
affairs.

• High maternal and child morbidity and mortality

Some of the consequences of early age marriage are delayed labor,

fistula and rupture of the bladder . These incidents occur because the
pelvics of the young girls is still fully undeveloped and narrow. Fistula is a
dirty injury that results in the loss of control of urine and stool which results
in incontinence and body smell. The young female victims of such
mishappening are segregated by communities. Furthermore, abnormal
labor often ends in child death.

• Early age - marriage focused preventing interventions:

There is an organized ongoing movement by interested against early age

marriage . The groups have to be assisted to over come and come out
victorious on the measures being taken to reduce the harmful traditional
practice. Some of the measures applied to prevent early age marriage
include the following .

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 • Families should receive sustained and adequate information and
education on this harmful traditional practice and their deadly
consequences.

• Disseminate and promote information on the legal age limit for marriage in
the rural areas.

• The government organizations and NGOs, should work with the

participation of the communities in disseminating information and
education related to the harmful traditional practices.

• Religious organizations should work on the prevention of early age

marriage in villages, churches, meeting places with participation of
communities and interested groups.

• Organize seminars, conferences, workshops etc to raise awareness on

early age marriage during public holidays and other occasions.

• Invite important personalities and groups to give lecture to sensitize the

public on the harmfulness of early age marriage and related
consequences.

4.3.4. Adolescent reproductive health related problems

4.3.4.1. Alcoholism The consequences of alcoholism on health

• Intoxicates brain and liver;
• Reduces appetite and causes protein and vitamin deficiencies;
• Reduces the capacity of understanding of prevailing situations and
gradually dives individuals into fight;
• Initiates pain in the stomachs and spleen;
• Induces heart and kidneys illnesses.

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Measures to prevent alcoholism:-

• Educate students in schools in the kebele on the consequences of

alcoholic drinks on their health.
• Disseminate adequate information and education to raise the awareness
of communities to enable them to participate in sustained efforts to
prevent the youth from alcoholism and its adverse consequences on
health and eventually to create alcohol free society.

• Provide adequate information and education to raise the awareness of

communities on alcoholism to help them grow their children with care, to
be responsible nationals.

• Young farmers often travel to nearby towns and village markets. They
drink alcohol as refreshment in these areas. Then these young farmers
get drunk and are triggered to fight between themselves or some of them
indulge in sex that may result in the infection of HIV/AIDS and other
sexually transmitted diseases. Therefore, the young farmers have to be
made aware that such incidents can happen using pamphlets, health
education in planned community meetings and other venues.

4.3.4.2. Highly addictive substances and drugs:-

Chat, hashish and cannabis are the major known addictive substances
that cause the following health and related problems.

• Decayed tooth;
• Loss of appetite;
• Constipation;
• Reduced sex desire and /or feeling;
• Mental illness;
• Isolate oneself from family and community social values;

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 • Inability or loss of desire to participate in all development activities,
schooling, farming etc,
• Participate in criminal acts; and
• Exposed to HIV/AIDS and other sexually transmitted diseases.

Measures to prevent health and related problems caused by addictive

substances and drugs:-

• Provide planned health education to communities in kebeles and in nearby

schools.
• In order to raise search and bring behavioral changes, provide adequate
information and education focused on the grave consequences of chat
and other addictive substances to communities in general and the youth in
particular. These activites should take place in youth forums in the form of
dramas, discussions etc. by elderly and religious people.
• The health extension workers in collaboration with the agriculture
extension workers should make continuous efforts to convince and
influence the youth and adult farmers to acquire their income by
harvesting other cash crops such as coffee, fruits, vegetables etc.
instead of the harmful chat and other addiction substances.
• Provide planned and continuous health education to the rural population
to use drugs officially prescribed by health workers and by collecting
them from clinics and rural drug vendors.

4.3.5. Social Problems:-

Social problems that affect the youth have also bearing on their health.
Some of the major anticipated problems include the following:-

• The act of sex harassment, abduction and rape on female youth;

• Assaulting and harming female youth;

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 • Attacking & abducting female youth for marriage;
• Migrating to cities in search of employment;
• Due to divorce and attraction by city-life, female youth migrate to
cities and become commercial sex workers;
• The absence of legal premises to allow female youth to have the
right to equal access to decision of properties and /or wealth
common to husband and wife;
• The female youth are forced by parents to be out of school and
married at early age.

Interventions needed to prevent social problems:

The activities of a health extension worker mainly focus on the prevention and
control of diseases. It is essential, however, that the extension worker clearly
understands and keeps record of the social problems of the youth, their
causes and contributing sources /factors and their health impact. The
prevention of social problems of the youth can be realized only if relevant
measures are applied with the full and active participation of communities and
by creating enabling environment for their implementation. In addition, the
following activities need to be undertaken.

• Create a mechanism for the sustained provision of adequate information

to raise the awareness and bring concrete behavioral changes in
communities to reduce and/or eliminate rape; abduction for forced
marriage and assault / victimization. If these harmful practices are let to
continue, the youth will be always exposed to HIV/AIDS and other sexually
transmitted diseases . In addition, the communities and the youth
association have to see and strongly participate that individuals or groups
involved in such harmful practices and sued are penalized for the crimes
they commit.

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• The youth that discontinues its education and /or due to lack of farming
land migrates to nearby towns and cities in search of alternate income
generating activities However, the youth ends up as street boys and girls,
commercial sex workers, and addicts. Consequently, the youth is
exposed to health related problems. To reduce the prevailing social and
related problems the measure to be addressed should include the
provision of land and the initiation to engage the youth in income
generating activities such as weaving, metallic works, making chairs and
beds from bamboo etc. Such activities must primarily be initiated by both
health and agriculture extension workers with the support of the kebele
council members. In addition, health education should be provided based
on identified prevailing problems.

• Female youth often leave schools to avoid being harassed and abducted
for marriage without consent and at early age. This harmful traditional
practice is becoming more and more common. To organize the youth and
communities at large to fight and prevent the abduction and raping of
females, adequate information and intensive education need to be given
on social and related health problems. In addition, enabling environment
has to be created for religious organizations, educational institutions,
women and youth associations, government organizations, and NGOs in
order to enlist their participation in the fight to reduce and/or eliminate the
harmful practices of female abduction and rape.

• Create enabling environment and establish adolescent reproduction health

centers where the youth can easily discuss among themselves adolescent
reproductive health and youth focused social problems.

• Organize in the youth center, meetings of professionals, elderly persons,

development workers, religious and tribal leaders to exchange their
experiences on youth health and social issues.

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4.4. Provision of adolescent reproductive health services:-
4.4.1. Establishment of adolescent reproductive health center:-

Activities on Youth Day:-

• Drama:- initiate the youth to prepare and show drama that

focuses on youth problems to communities.
• Play /dialogue :- Initiate the youth to stage exciting and
educational but short play /dialogue to the youth at large.
• Short-writings:- initiate the youth to prepare short writings in
conjunction with nearby schools to be presented on the Youth
Day.
• Organize Youth peers to discuss on issues and problems
related to adolescent reproductive health.

4.4.2. Establishment and organization of youth recreational facilities:-

Establish youth recreational centers with rooms and other spaces
for traditional sports activities and meetings. This will keep away
the youth from harmful environment.

4.4.3. provision of family planning and reproductive health services:

• Provide counseling service to the youth that wants to utilize

family planning health services; and
• Promote and distribute condoms to prevent the youth from
HIV/AIDS and other sexually transmitted diseases;

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5. Expected outputs /Results:

1) The youth knows about the development and function of

reproductive system and organs.
2) The community awareness on the health and other social problems
such as female abduction, rape, the use of addictive substances
(chat, cannabis, hashish etc); alcohol, early age marriage, female
genital mutilation etc. would have improved. This would have been
achieved by the dissemination of adequate information and
education. Hence, the youth social and related health problems
would be reduced through the concerted efforts of the youth and
the community at large.
3) The youth would have received adequate information and
education on HIV/AIDS and other sexually transmitted diseases.
Hence, the youth would practice:-

• One to one sexual relationship;

• Abstain from any sexual engagement before marriage;
• Refrain from any harmful traditional practices that make damage
to the body; and
• Use condom.

4) The youth would have started to use effectively family planning

services to prevent itself from adolescent reproductive health
related problems such as unwanted pregnancy and abortion.
5) Improved healthy reproductive health behavior including abstinence
of casual sex would be observed in the youth.
6) The youth would establish forums that serve to organize the youth
in general to address and/or tackle problems related to reproductive
health.

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 7) Students in schools in the kebele would benefit from the adolescent
reproductive health programmes or services.
8) The youth would have the knowledge and skills to openly explain
about the grave consequences of early age marriage to their
families that intend to marry them at an early age. And gradually
the youth will be able to reduce and/or eliminate the harmful
traditional practice.
9) Accidental and unplanned pregnancies would have been reduced.
10) The number of youth that leaves school because of pregnancy
would have decreased.
11) The number of the activists of the adolescent reproductive health
services would have increased.

6. Information, Communication methods for adolescent

reproductive health:-

• Providing counseling services: Provide counseling on reproductive

health to young individuals who reside in the kebele.

• Establish peer youth forum: Organize the youth to develop and

present-educational information /messages through dialogue,
drama etc. on harmful traditional practices (female abduction, rape,
early age marriage etc.) applied on the youth and reproductive
health related problems ( unwanted pregnancy, HIV/AIDS and other
sexually transmitted diseases, abortion etc).

• Prepare relevant messages /information on health and social

memorial Days: For special memorial days such as the World
Health Day; children’s Day; Women’s Day etc. disseminate
relevant information and messages by using:-

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 - Pamphlets and leaflets;
- Posters;
- Slogans; and
- Musical bands /orchestra etc.

• Information /messages disseminating methods on traditional and

religious holidays:-

Prepare and dissiminate relevant health education messages on

Sundays in churches; Id Al Adaha; Mauled, Id Alfater /Remadan,
Juna Friday and using other traditional holidays celebrated in the
areas.

• Drama representing characters of personalities as a method to

transmit messages / information: Producing and staging plays that
depict particular character of personalities based on real
experience in life and based on the available local knowledge and
skills as fits to the youth. The play must be prepared and
presented in ways that trigger discussions.

• Disseminating health messages /information via short dramas:-

Prepare and present written health messages/information on

adolescent reproductive health related problems. These messages
can be studied and memorized to be presented as recreational or
educational dramas by peer youth to the youth in general and
communities. However, the preparation and presentation of the
drama should take into consideration the culture, practice and
values of the communities:
• Dissemination of health messages using mass-medias;
• Reading materials:- leaflets and magazines;

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 • Visual aids, posters, charts often posted on walls;
• Groups training flip chart; and
• Presenting printed pictorial health messages focusing on
adolescent reproductive health.

7. Information management, monitoring and evaluation

system:

• Tasks of the health extension worker:-

- keep record of the number of the Kebele population
categorized in sex, age and occupation;
- Keep record of the number of schools, government and non-
governmental organizations, farmers, youth and women’s
associations found in the Kebele;
- Register the number of health education materials
distributed to social and other organizations in the Kebele;
Keep record of the number of people that received health
education as group or in any gathering places;
- Register all new clients of family planning services.
- Keep the record of the number of households referred to
higher health institutions by the health extension worker.
The record should include information on whether the client
has benefited or not from the next level of health facility;
- Compile daily performed activities. Prepare and submit
monthly, quarterly and annual reports to the woreda health
office. The reports should contain the achievements,
outcomes, benefits and problems encountered during the
implementation of the package.

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• Activities implemented by wereda health office:

The Wereda health office in collaboration with the kebele council

will conduct quarterly or as deemed necessary sustained
supportive supervisory visits to the health extension worker to
ensure that the health extension package implementation has been
progressing satisfactorily and to discuss and resolve problems and
constraints encountered by the worker. In addition the Woreda
health office compiles monthly reports received from the health
extension workers and submits them quarterly to the Regional
Health Bureau.

• Activities implemented by the Regional Health Bureau (RHB)

and the Federal Ministry of Health (FMOH):-

- Develops a standard health extension activity

implementation reporting format;
- Quarterly reports of the Wereda office will be compiled by
the RHB and submitted to the FMOH;
- Assessment of the progress of the health extension
package implementation will be conducted in collaboration
with all stakeholders (Kebele council, government
organizations, NGOs and beneficiaries) of the health
extension package biannually by the RHBs and annually by
the FMOH.
- Based on the findings of the assessment, the achievements
made, the problems and gaps encountered will be analyzed.
On this basis the FMOH and RHBs will formulate improved
strategy document for better work in the future.

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- The FMOH will prepare a report that contains observations
made on the achievements, best practices, problems, gaps
and measures taken to enhance the health extension
package implementation. This report will be distributed to
the RHBs. Similarly, the RHBs will coordinate the
assessment of activities implemented by the Woreda health
office. The report of the assessment findings will be
distributed to the Woreda health office and the FMOH.
- The FMOH will conduct annual review meetings of the health
extension package in which all regions involved in the
implementation of the package participate. Report on the
proceedings and results of the health extension package
annual review will be distributed to the RHBs and woreda
health offices. The report contains the recommendations
and plans of action for implementation.
- When deemed necessary questionnaires for data collection
on the progress of the implementation of the package will be
designed and distributed to all stakeholders by RHBs and/or
FMOH, Woreda health offices and health extension workers
to fill and return. This will serve to improve or strengthen the
implementation of the package.

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