Community Pathways to Improved Adolescent Sexual and Reproductive Health: A Conceptual Framework and Suggested Outcome Indicators

This 42-page paper, developed by the Inter-Agency Working Group (IAWG), advocates for a better articulation of community-involvement processes and for more comprehensive measures of outcomes of community involvement interventions. Co-chaired by the United Nations Population Fund (UNFPA) and CARE, the group's active members include: Advocates for Youth, CARE, Pathfinder International, Save the Children-USA, and UNFPA.

From the introduction: "There remains a need for more rigorous research designs to establish better empirical evidence of the contribution of community involvement to health outcomes, including evaluation research of adolescent sexual and reproductive health (ASRH) programs.... Recognizing the wide range of community involvement outcomes, ASRH programs need to measure social-change effects that result from involved communities (e.g., girls allowed to stay in school instead of marrying early) as systematically as are individual and structural changes. To further thinking on these program and measurement issues, the Inter-Agency Working Group on the Role of Community Involvement in ASRH was formed at the end of the 2005 YouthNet/CARE technical consultation, with a mandate to develop a conceptual framework and propose outcome level indicators that articulate and measure the full impact of community involvement in improving ASRH."

This intervention framework attempts to capture the dynamic nature of community involvement, i.e., that collective action is likely to improve the capacity of a community to address other pressing issues. Communications aspects of this intervention framework for changing community norms and practices include:

• Community dialogue and debate, often following a catalytic event of community, family, or individual concern.
  
• Community capacity assessment and capacity building .
  
• Developing the leadership skills of individuals in the community.
• Strengthening existing organisations, or creating new ones that can more effectively engage in community-focused activities.
• Strengthening community governance, ensuring equity in representation, and mobilising individuals for collective action.
  
• Promoting collaborative partnerships and inter-organisational collaboration.
• Community involvement, meaning: development of collective action by engaging in dialogue with community members; encouraging them to analyse and act on issues of concern; treating them as partners; and engaging community leaders as active advocates. This includes collaborating with the gatekeepers (e.g., traditional leaders, religious leaders, school principals, and influential parents.)
  
• Making information and services available to adolescents through well-designed and supported community-involvement interventions.
  
• Involving youth in ASRH programmes to provide them with new skills and capacities that enhance their status and demonstrate what young people can bring to community development.

The framework begins by examining community capacity around ASRH issues to establish a baseline, particularly on the community level of ASRH awareness. The document lists dimensions and outcome indicators as:

1. Dimensions of measurement of individual change (e.g., self-image and social influence, among 10 dimensions) - adolescent and adult outcome indicators (e.g., knowledge of ways to prevent pregnancy and HIV infection, and adults' intention to grant adolescents rights to sexual and reproductive health (SRH) information and services , among 8 adolescent indicators and 5 adult gatekeeper indicators);
   
2. Dimensions of social change and community engagement (e.g., leadership and degree and equity of participation, among 7 dimensions) - outcome indicators: changes in perception of how leadership acknowledges ASRH issues as community issues and improved communication between parents and adolescents on ASRH issues, among 10 indicators;
   
3. Dimensions of measurement of structural change (e.g., programme management asset base and inter-organisational connections, among 7 dimensions) - outcome indicators: organisational capacity to design and implement ASRH interventions and existence of laws and policies supportive of ASRH rights, among 8 indicators.

In conclusion, "the IAWG framework is intended to provide greater clarity on 1) how community involvement leads to a range of health and non-health outcomes and 2) the interrelationships between community capacity, participation, and outcomes....While the conceptual framework is not an evaluation framework and does not have a temporal element that would show sequencing of community involvement activities, which is important in community engagement work, it could guide the development of a logical framework, with expected individual, structural, and social outcomes. A related program action plan could provide the initial ordering of community involvement activities."