ADRA Leadership Development Program - Youth Friendly Services in Cambodia


Background:

The need to improve health delivery systems in Cambodia is seen most clearly in the low level of health facility attendance by the country’s rural population.  In the critical area of reproductive health (RH) services for youth, the barriers to youth access in this rural context include lack of confidentiality, poor relations with health staff, illiteracy among the population, low prioritization by parents for RH services, and plain shyness.  In recognition of the need to provide youth with opportunities for improved mental, social, and physical health, the government of Cambodia has begun work on a National Youth Policy including a set of national guidelines for Youth Friendly Sexual Reproductive Health services (YFSRH) to be implemented by the Ministry of Health (MOH).  This policy effort was aided by the contributions of NGOs active in the youth sector, including ADRA Cambodia. 

In light of a mandate to implement the YFSRH standards at the shealth facility level, ADRA identified a need to build the capacity of health center teams and youth groups to foster a sene of trust and affinity between the two groups around RH topics and services.  Through the implementation of the Leadership Development Program (LDP) developed by Management Sciences for Health (MSH), ADRA sought to strengthen the leadership and management skills of health service providers at 13 MOH health centers, and to empower community youth to speak up for their health rights by building their leadership and advocacy skills.  In January 2009, the pilot project for health facilities and youth began in the Chamkar Leu-Steung Trong district of Kampong Cham province.  The effort was supported by a grant from MSH/USAID.

Measuring changes in work environment:

The Work Climate Assesment (WCA) is an important tool for benchmarking any change in workplace climate as perceived by the employees.  As part of the Cambodia Youth LDP, the WCA was offered before the LDP intervention, half way through, and at the conclusion of the program.  The graph below represents the three sets of results from the Speu Health Center LDP team and is a shining example of a perceived improvement in quality, productivity, and work climate in the health center as employees worked through the LDP modules as a team.  An evaluation of the program conducted by ADRA in June 2009 reported that the improved work climate was exemplified by “more delegation of responsibilities, clearer roles and responsibilities of staff, improved team work environment, corrective feedback rather than apportioning blame”.

Results:

Many positive results came out of the pilot Youth LDP in Cambodia.  ADRA’s evaluation documented many accounts of growth on an individual level, in the health centers and their communities: “Health center staff were able to mobilize stakeholders to become involved in disseminating youth reproductive health information and encouraging the participation of youth in the youth groups…The project has contributed to community mobilization and improved collaboration between stakeholders.”  Of the youth, it was reported that “through the focus group process, the youth groups provided a positive vehicle for youth to learn very important Leadership and management skills, learn about RH issues, engage with and support other youth, and engage with local authorities.  This process of participation and building of confidence and self esteem is a positive outcome in society”.

Success at the health center:

Mr. Heng Kim Leang is the Health Center Chief of Dankdar-Aumlou Health Center.  He reports that since he has joined the Leadership Development Program (LDP) Workshops 1 and 2, he has applied the LDP theory with both his family and his staff.  Before attending the LDP workshops, Mr. Leang says that he was a stubborn guide who never listened to others – even his mother and his wife. He made decisions without discussion with his family member or his staff. Mr.  Leang says that he always blamed his family members as well as his staff when they made mistakes, he never acknowledged them when they did something good, and his business did not improve.

After the LDP workshops Mr. Leang tried to implement what he had learned. He changed his behavior a lot and he began discussions with his family before deciding to do something.  He also listened to other staff members’ ideas.  He approached the challenges and problems related to Youth Friendly Sexual Reproductive Health Service (YFSRHS) in his Health Center by using the 8 practices of managing and leadership. Now his personal business, his family environment and Health Center staff work climate are all improving as well as the YFSRHS at his Health Center. Also, Mr. Leang reports that he has persuaded six of nine youth who left school and attended the Leadership Development Program workshop held at ADRA’s JamboK Hoas Adventure and Learning Centre to re-enroll in school.  He has also motivated some of his friend who always had conflicts with each other to use some LDP tools such as giving positive feedback, making requests instead of complaining, gaining and maintaining trust and leading change initiatives to challenge his friends’ family conflict problems.

At the Turn Up the Volume Evaluation Dissemination Workshop, Mr. Leang was able to share his experience with the LDP to encourage other people that good change will happen through the LDP process.

Success for community youth:

Khon Sok Na is a 22 year old youth leader from Thlok Kra Vann village, in the Kampong Cham Province. Sok Na said that he had never considered himself of value. He always thought that he could not do anything because he failed his examination at the 12th grade. When he heard that he was expected to arrange youth meetings without snack or per diem, he did not think he could do it.
Sok Na has always worked by himself and was not involved in social settings.  He thought that he could not explain and encourage other students to work with him in a youth group because he had failed his examination.

Since Sok Na attended his first Leadership Development Program workshop with the Turn Up the Volume project he was very happy and he was very interested in the project. 
He enjoyed the experiences on leading and managing and he applied the technique of scanning, focusing, aligning/mobilizing and inspiring, planning, organizing, implementing, and monitoring and evaluation to real situations in the community. Sok Na aligned authorities and other youth to join and support his group. He arranged meetings for sharing knowledge with community youth. He also inspired others to pay for snacks for the meetings.

At the end of project evaluation dissemination workshop, Sok Na was not afraid to speak his mind and share his concerns for his youth group with all in attendance – including high level government officials.  Sok Na now knows that he does have value.