EC SRH Strategy Promotes Youth SRH Knowledge & Services

CONTENTS
EC SRH Evidence Based Strategy 2015-2020
Evidence Based SRHR
Communications Strategy
2016-2020
Foster adolescents’ transition into responsible and dignified adults.

Abbreviations …………………………………………………………………………………………………………………………………………..3
Foreword ………………………………………………………………………………………………………………………………………………… 4
Acknowledgements …………………………………………………………………………………………………………………………………. 5
Executive Summary …………………………………………………………………………………………………………………………………. 6
Introduction……………………………………………………………………………………………………………………………………………… 8
Strategic Linkages ……………………………………………………………………………………………………………………………………. 9
Organizational Background………………………………………………………………………………………………………………………. 9
Project Goal and Objective …………………………………………………………………………………………………………………….. 9
Situation Analysis……………………………………………………………………………………………………………………………………..10
Guiding Principles ….......................................................................................................................................11
Behavioural Models and Analysis …………………………………………………………………………………………………………….12
Target Audiences …………………………………………………………………………………………………………………………………… .16
Strategic Communication Framework ...........................................................................................................17
Monitoring and Evaluation………………………………………………………………………………………………………………………..28
Partnerships for Sexual and Reproductive Health ……………………………………………………………………………………..29
Costed Implementation Plan …………………………………………………………………………………………………………………….30
Appendices………………………………………………………………………………………………………………………………………………..40
References ………………………………………………………………………………………………………………………………………………. 40

ABBREVIATIONS
AIDS-Acquired immune-deficiency syndrome
HIV-Human immune-deficiency virus
IUCDs-Intrauterine contraceptive devices
SCI-Save the Children International
SRH-Sexual and reproductive health
SRHR- Sexual and reproductive health rights
MDG-Millennium development goals
CPR-Contraceptive prevalence rate
FP-Family planning
EC-SRHR-European Commission- Sexual and reproductive health rights
YFHS-Youth friendly health services
MDHS-Malawi Demographic and Health Survey

FORWARD
Save the Children International (SCI) is committed to ensuring that children survive, thrive, and are protected from harm. Within our work we
recognize the unique challenges facing Malawi’s children and young people throughout their life cycle, from birth to adulthood, including young
people’s sexual and reproductive health. Young people face numerous barriers to accessing sexual and reproductive health services and
information—hindering their ability to pursue education, delay pregnancy, and plan for an economically secure future. These barriers include
prohibitive gender and cultural norms, the prevalence of myths and misconceptions on modern contraception, fear of judgment from service
providers, lack of parental and community support, and inappropriate age-appropriate resources for young people.
With a focus on the specific biological, physical, emotional, and cognitive needs of boys and girls as they grow and develop, Save the Children is
working with various government departments, local, and international partners to advance strategies for protecting the sexual and
reproductive health and rights of young Malawians. Our efforts target the broad array of institutions and actors that interact with young people
and influence their ability to attain information and services related to sexual and reproductive health. These include health providers, schools,
parents, community members, religious leaders, and many others. The purpose of this communications strategy is to target these different
groups with accurate and relevant messaging on youth sexual and reproductive health in order to combat misconceptions, barriers, and gender
norms that prevent universal access.
This communications strategy—part of the European Union-funded Comprehensive Sexuality Education and Family Planning for Protection and
Empowerment of Adolescents and Women in Malawi project—is a positive step forward in promoting the rights of young people to achieve their
fullest potential. With the committed efforts of partners and communities, we will continue to make progress on addressing the reproductive
health needs of young people, ensuring they are protected from disease, and protecting their rights to decide when, and if, to have a family.
David Onunda
Acting Country Director

ACKNOWLEDGEMENTS
Save the Children wishes to express its gratitude to individuals and organizations who contributed to the development of this evidence-based
communications strategy. Without their input, this document would not have been possible. Save the Children is particularly indebted to the
Ministry of Health (Health Education Unit and Reproductive Health Directorate), Banja La Mtsogolo, Christian Association of Malawi, Kamuzu
College of Nursing, Family Planning Association of Malawi and National Youth Council of Malawi for their leadership in all phases of the strategy
development process, from planning to finalization. This communication strategy is strengthened as a result of the collaboration amongst these
organizations working tirelessly to promote positive health outcomes in Malawi.
Save the Children would also like to thank the following people for their technical input and active participation in the process of developing this
strategy: Tobias Kunkumbira, Austin Makwakwa, Alvin Chidothi and Ella Chamanga (Health Education Services-MOH), Hans Katengeza
(Reproductive Health Directorate MOH) Pacharo Simwaka and Prescilla Zikapanda (CHAM), Sanjay Singh and Patrick Zgambo (BLM), Asharn
Kossam (NYCOM), Esmie Mkwinda (KCN), Henry Nyaka (FPAM), Grevasio Chamatambe, Mirriam Chitulu, Harrison Sikalamwa, James Kalulu,
Frank Mwafulirwa, Elvis Sukali and Jamee Kuznicki (SCI Malawi). Special thanks to Shannon Pryor (SC-USA) for her unlimited technical support.
Finally, Save the Children wishes to express profound gratitude to the European Union’s commitment to improving the health and wellbeing of
Malawi’s young people by providing financial support to the EC-SRH project and indeed the development of this Evidence-Based
Communications Strategy. This project would not be possible without the EU’s generous financial and technical support, of which Save the
Children is incredibly grateful.
David Melody
Health and Nutrition Director

EXECUTIVE SUMMARY
With financial support from the European Commission, SCI and partners (BLM, CHAM and KCN) are implementing a five-year adolescent sexual
and reproductive health project called “Comprehensive Sexuality Education and Family Planning for Protection of Adolescents and Women in
Malawi.” The project has four result areas: (1) Increasing access and availability of SRH services, (2) improving quality of SRH services, (3)
creating demand for SRH services, and (4) creating a more favourable and supportive environment for SRH.
This evidence-based communication strategy directs the development and execution of Sexual and Reproductive Health communication and
advocacy messages, materials and activities under results 3 and 4. The strategy development is informed by the SCI 2015 baseline and barrier
study, MDHS 2010 and other studies. Among major findings, the baseline and barrier studies revealed that sexual debut starts as early as 11
years in the project area; the majority of sexually active youths did not seek SRH services; and SRH services were not readily available to youth.
This communication strategy is aligned to both global aspirations and Malawian National interests. The strategy is linked to the global FP 2020
partnership, whilst on the national level, the strategy has been developed in line with the National Youth-Friendly Health Services Strategy
(2015-2020), National Youth Policy, the Health Sector Strategic Plan 2012-2016, the National Health Promotion Policy, the Strategic Plan (2016-
2018) for Save the Children International and the SCI campaign aimed at reaching Every Last Child.
The overall goal of this strategy is to contribute to the adoption of positive SRH behaviours among adolescents, youth, men and women and
their families through improved access to SRH services in hard-to-reach and underserved areas of Malawi.
Specifically, this strategy intends to increase the proportion of adolescents and youth (15 to 24 years old) who seek SRH services in different
outlets in the project area. Secondly, it intends to raise the proportion of adolescents and youth (10 to 24 years old) who demonstrate a
comprehensive knowledge on SRH from 65% to 95% by January, 2020. Lastly, this strategy aims to increase, by 20%, the proportion community
members including parents and community leaders who openly support use of SRH services, particularly contraceptives.
This strategy not only highlights eight issues that require communication interventions, but it also identifies desired behaviours for each issue
and the barrier that may hinder people from performing each. Additionally, this strategy lists the target audiences and corresponding key
messages directed at the various groups. The document further demonstrates a multi-media approach for advocacy and for creating demand
for SRH services. SCI will therefore partner with different organizations, media houses (electronic, social and print), community based
organizations, local leaders, parents and young people in implementing this campaign.

This document also contains a strategic work-plan providing a timeline for the various demand creation and advocacy activities. It also indicates
resources needed for the campaign. Lastly, this strategy includes a monitoring and evaluation system which identifies how different indicators
will be tracked and how activities will be undertaken to strengthen and enhance oversight of the campaign performance. SCI needs to conduct a
rapid mini-study to fill information gaps related to key indicators.

1. INTRODUCTION
Save the Children International (SCI), Malawi, and partners are implementing a five-year project called “Comprehensive Sexuality Education and
Family Planning for Protection and Empowerment of Adolescents and Women in Malawi” (herein referred to as EC-SRH). This project responds
to the difficult reality that young people (10 to 24 years old) — who account for 32.3% of Malawi’s population (MDHS 2010) — still do not have
access to age-appropriate SRH services despite being the most at-risk group. According to the same MDHS 2010, one in every four Malawian
teenagers (26%) begins child bearing between ages 15 to 19 years old. Additionally, (27%) of teenagers in rural areas begin child bearing as
opposed to 21% in urban areas.
The overall objective of the project is to secure improved wellbeing of vulnerable boys and girls, men and women and their families through
improved access to SRH services in hard-to-reach and underserved areas of Malawi. The specific objectives of the project are to:
• Reduce pregnancies and early motherhood among adolescents (10 to 19 years old).
• Reduce unplanned pregnancies among sexually active young women (15 to 24 years old).
• Reduce high-risk child bearing among sexually active young women (15 to 24 years old).
• Increase adoption of safe sexual and reproductive health behaviours among youth (10 to 24 years old).
In partnership with the Ministry of Health, Kamuzu College of Nursing (KCN), Christian Health Association of Malawi (CHAM), Banja La Mtsogolo
(BLM) and District Councils (DCs), the project is being implemented in five hard-to-reach districts – Neno, Mwanza, Ntchisi, Nkhata-Bay and
Rumphi. Primary beneficiaries of the project are 160,000 adolescents and young women aged 10 to 24 years old. Among these are 2,440 teen
mothers and 2,440 people living with HIV and AIDS.
The four strategies developed to achieve the objectives include:
• Improving access to high quality family planning (FP) and HIV and AIDS services for adolescent and young women aged 10 to 24 years old
through innovative approaches of service delivery.

• Improving and sustaining the quality and range of available sexual and reproductive health services through partnership with training
institutions and public and private service providers.
• Increasing sexuality education and awareness on FP issues among underserved women and young people in order to reduce the
adoption of risky behaviours and harmful practices.
• Strengthening accountability and capacity of coordination of SRH services at community, district and national levels through leadership
by District Councils and Ministry of Health and proactive civil society engagement.
2. STRATEGIC LINKAGES
This communication strategy has been developed in-line with the National Youth-Friendly Health Services Strategy (2015-2020), the National
Youth Policy, the Health Sector Strategic Plan 2012-2016, Family Planning 2020, the National Health Promotion Policy, and the Strategic Plan
(2016-2018) for Save the Children International.
3. ORGANIZATIONAL BACKGROUND
3.1 Vision
A world in which every child attains the right to survival, protection, development and participation.
3.2 Mission
To inspire breakthroughs in the way the world treats children, and to achieve immediate and lasting change in their lives.
4. PROJECT GOAL AND OBJECTIVES
4.1 Goal
To contribute to the adoption of positive SRH behaviours among adolescents, youth, men and women and their families through improved
access to SRH services in hard-to-reach and underserved areas of Malawi.

4.2 Objectives
1. To increase the proportion of adolescents and youth (15 to 24 years old) who seek SRH services by 40% by January, 2020.
2. To raise the proportion of adolescents and youth (10 to 24 years old) who demonstrate having comprehensive knowledge on SRH from
65% to 95% by 2020.
3. To increase by 20% the proportion of parents and community leaders who openly support use of SRH services – particularly
contraceptives – through YFHS centres and youth clubs by February 2020.
5. SITUATION ANALYSIS
Young people (10 to 24 years old) – who account for 32.3% of the Malawian population (MDHS 2010) – are the most exposed to SRH related
risks yet they still do not have access to age-appropriate SRH services. Adolescent girls, for example, are at a higher risk of developing maternal
complications including death. This is often due to their immature reproductive organs. A SCI study conducted in 2015 revealed that adolescent
maternal deaths account for 20.6% of all maternal deaths in Malawi. The fertility rate among adolescents aged 15 to 19 years old in Malawi is
high – 177 births per 1,000 women – (MDHS 2010).
The National Youth Policy prioritizes family planning initiatives which discourage early pregnancies among Malawian youth. A baseline survey
conducted in 2015 in the project’s five districts -- Mwanza, Neno, Ntchisi, Nkhata Bay and Rumphi – indicated the following:
• Child bearing starts as early as 11 years old.
• 21% of girls aged 15 to 19 years old and 1.1% of girls aged 10 to 14 years old had already given birth.
• 10% of youth (10 to 14 years old) had already engaged in sexual activity.
• The contraceptive prevalence rate (with modern methods) is at 45% (on average) across the five project districts. 32% of married couples in
the five districts have an unmet need for family planning. This is higher than that quoted in the MDG 2014 End-line Survey which is 19.4%.
• Injectable contraceptives are the most common contraceptive used by married people in union (28.1%) as opposed to 2.6% for those not
married.
• Individuals not in union (43.6%) opt for male condoms as a means of contraception as opposed to 10% for those in union.
• Uptake of long acting and reversible contraceptives is relatively poor with implants at 10.4% and IUCDs at 0% among youth aged between
15 to 24 years old and in union. This is influenced by prevailing myths and misconceptions including that the IUCD can migrate into the
abdominal cavity.
• Nearly 65% of the 15 to 24 year olds are aware of at least three modern family planning methods.

• 31% of youth between 10 to 24 years old have heard about YFHS.
• Less than 10% of youth (10 to 24 years old) know where to access YFHS.
• More boys access YFHS than girls. For instance, only 6% of male and 4% of female adolescents 10 to 14 years old reported having accessed
youth friendly health services. Similarly, 21% of male and 14% of female adolescents 15 to 19 years old reported having accessed YFHS.
According to the baseline survey, key barriers to the access and use of SRH services include long distances to service delivery points, lack of
privacy, poor provider attitude and restrictive cultural and religious beliefs and attitudes toward utilization of FP and other SRH services by
adolescents and youth.
6. GUIDING PRINCIPLES
The EC-SRH Communication Strategy is guided by several principles based on the philosophy outlined in the Save the Children Global Strategy,
Family Planning 2020, National Youth Policy, National Youth Friendly Health Services Strategy, National Health Promotion Policy and the Health
Sector Strategic Plan. The guiding principles include:
1. Evidence-based decision making.
Strategic communication and health promotion efforts will be based on evidence derived from research and tested innovations and best
practices. These will be aligned to theoretical models. This includes making the most productive use of appropriate technologies based on the
audiences’ learning needs and resources available.
2. Communication is a process.
Health Communication is an on-going process of working with the population to ensure they have the relevant information and live in an
enabling environment so that they can take actions that sustain and improve their health. It builds on what has been done in the past and
serves as the foundation for future efforts.
3. Effective collaboration, coordination and partnership.
All relevant partners should work together to ensure that the sexual and reproductive health needs of adolescents and youth aged 10 to 24
years old are met. To achieve this there is need to have strong collaboration and linkages among all sectors and stakeholders.
4. Gender Equity and Social Inclusion

Many gender related norms, expectations and beliefs act as barriers to accessing SRH services by adolescents, young women and men. Health
communication efforts therefore should foster critical examination of the gender norms that negatively impact health outcomes and promote
those that influence positive actions. At all times, SRH communication efforts will be gender sensitive and never gender exploitative. Actions
which encourage individuals, households and communities (boys, girls, men and women) to work together as equal partners will be actively
promoted. In addition, health communication efforts will address the needs of the people in hard to reach and under-served areas as well as
the poor and most vulnerable groups who are too often ignored.
5. Voices of ordinary people and community participation should be prominent.
There will be deliberate efforts to ensure that the voices of ordinary people are utilised to address the needs of specific groups in the
community. There will be active participation by the community in all SRH activities. This is important because communities often have tested
solutions for mobilizing and addressing common health challenges. Channels should be provided for youth, parents, community leaders and
others to debate on SRH issues within the perspective of their communities and undertake actions together to achieve better health. This will
help lead to better localized, home-grown, sustainable solutions.
7. BEHAVIOURAL MODELS, ANALYSIS AND TARGET AUDIENCES
7.1 Behavioural models
This EC-SRH communication strategy is guided by the social ecological model of communication and behaviour change with the premise that
individuals function within culturally determined social networks and communities. To make an impact on SRH, communication interventions
need to take place at all levels – individual,
interpersonal, and societal. Furthermore,
health and wellbeing cannot be
conceptualized as merely individual-level.
Therefore, this EC-SRH communication
strategy uses the Socio-Ecological model
(see figure 1) as its primary foundational
approach.
Figure 1: The Social Ecological Model

Theories of behaviour and social change further inform the strategy. At the individual level, the approach is based on the Extended Parallel
Process Model (Witte, 1992). This model perceives individual behaviour change as being (a) motivated by people’s desires to reduce their risk
and (b) facilitated by enhancement of personal ability to bring about change. At the interpersonal level, principles from the Theory of
Normative Social Behaviour (Rimal, 2008), which conceptualizes behaviour change as being determined by interpersonal and social network
influences have been incorporated. Finally, at the socio-cultural level, principles from Social Epidemiology (Lisa F. Berkman and Ichiro Kawachi,
2000), in which individuals’ choices, decisions, and behaviours depend not only on their own characteristics, but also on group or community
characteristics have been integrated.
7.2. Behaviour Analysis
Communication interventions promote particular behaviours by addressing certain challenges and barriers. Below, table 1 shows analyses of the
situation for SRH social and behaviour change communication in the impact districts.
Table 1: Behaviour analysis matrix

Existing behaviour
(issues)
Desired behaviour Barriers Enablers
1. Most youth
requiring SRH
services do not
seek the services.
Majority of youth
requiring SRH services
should seek the
services.
• Judgment and negative attitude of
providers.
• Disapproval of some parents and
community members.
• Teachers are uncomfortable discussing
SRH issues with youth.
• Long distances to SRH service centres
(health centres).
• Inadequate information.
• Cost of transport, visits, and time may
be prohibitive.
• Shyness.
• Youth fear gossip due to lack of
confidentiality/privacy when accessing
services.
• Messages are not packaged to meet
youth needs.
• Religious beliefs discourage youth from
accessing SRH information.
• Presence of YFHS providers who can provide
correct SRH information to youth.
• Presence of CBOs to conduct awareness-
raising activities with communities, parents.
• CBDAs can provide services and information.
• There are some IEC materials that have SRH
information.
• Ministry of youth, youth clubs, churches, NGOs
can provide information.
• Presence of teachers trained in life skills.
• Some churches have youth counsellors who
can be trained to provide SRH information.
2. Most sexually
active youth do not
use contraceptives.
Sexually active youth
should use
contraceptives.
• Judgment and negative attitude of
providers, parents, and community.
• Prohibitive cost of travel to YFHS
centres.
• Inadequate information on correct
usage.
• Improper channelling of messages to
youth.
• Stock outs of FP commodities.
• Religious beliefs discourage use of
modern methods of family planning.
• DHMT is supportive of SRH services.
• There are IEC materials that have SRH
information.
• Presence of YFHS providers who can provide
correct SRH information to youth.
• CBOs to conduct awareness-raising activities
with communities and parents.
• CBDAs can provide services and information
and address distance.

3. Some service
providers are
judgmental toward
youth who come to
seek SRH services.
All health providers
should provide YFHS
(incorporates a
positive attitude).
• Work load due to low staffing levels.
• Some health workers are not trained in
YFHS.
• Poor attitude of health workers toward
youth seeking SRH services.
• There is a youth reproductive health policy
that supports youth rights to access SRH
services.
• Some communities have active Health Facility
Advisory Committees which can handle
grievances of youth.
• DHMTs – quality inspection, enforcing
standards.
• YFHS training to service providers.
• Performance based incentives is present.
4. Some traditional
initiation
ceremonies include
aspects that
encourage youth to
engage in
premature and
unprotected sex.
Traditional counsellors
should provide
information to
discourage risky SRH
practices to their
initiates.
• Gender/cultural norms.
• Low literacy levels.
• Limited/lack of information on SRH
among initiators.
• Conservative traditional leaders
influence counsellors.
• Traditional leaders – if they’re behind the idea
they can push for it.
• Presence of village meetings.
5. Community
members and
parents may not
approve use of
contraceptives
among unmarried
youth --
particularly girls.
Parents should
encourage youth to
seek SRH information
& services.
Community members
should endorse (speak
well of) sexually active
youth who seek SRH
services.
• Limited knowledge about SRH issues.
• Some religious institutions discourage
followers from accessing modern
contraceptives.
• Community members and parents
believe contraceptives are only for
married people.
• Community members have limited
knowledge about SRH challenges
(dangers of teenage pregnancies,
unsafe abortions, teenage parenthood,
STIs); denial that the youth face.
• The belief by some parents that their
children are not sexually active.
• Existence of youth clubs/CBOs in disseminating
information.
• Government policies i.e Reproductive Health
Policy; Youth Friendly Health Services Policy,
allow young people to access SRH services.
• Use of mother groups to disseminate SRH
information.
• Use of safe motherhood committees to
disseminate information.

6. Some parents do
not discuss SRH
issues with their
adolescents.
Parents should share
correct SRH
information with their
adolescents.
Parents should seek
correct SRH
information.
Parents should
encourage their
adolescents to attend
SRH gatherings (Youth
clubs).
• Social distance between parents and
their children.
• Inadequate knowledge about SRH
issues.
• Use of existing radio health programs which
encourage communication between parents
and children.
• Use of village meetings.
• Presence of CBOs.
7. Some
community leaders
do not approve use
of contraceptives
among unmarried
youth --
particularly girls
10-19 years old.
Community leaders
talking openly in
support of unmarried
youth seeking and
using contraceptives
and SRH services.
• Misconceptions that contraceptives
cause infertility and promote
promiscuity.
• Religious teachings that discourage use
of modern contraceptives.
• Lack of comprehensive knowledge on
SRH and contraceptives.
• Existence of community structures which
form fora for sharing information and
community issues i.e. VDC, ADCs.
• Presence of institutions working at
community level which can assist in
implementation of the project. Ie. Radios,
CBOs, YOs, Mother Groups.
• Presence of already allied traditional and
religious leaders, leaders.
8. Most unmarried
youth shun long-
acting and
reversible
contraceptives
(LARCs).
The youth seeking and
using long-acting and
reversible
contraceptives.
• Fear of side effects of long-acting and
reversible contraceptives.
• Lack of comprehensive knowledge on
how LARCs work.
• Community and parents disapprove of
youth using LARCs.
• Availability of trained health workers who can
provide elaborate information about LARCs.
• Availability of community groups including
CBOs, YOs, and mother groups that can help
disseminate information about LARCs.
• Availability of SRH policy supporting provision
of information about LARCs to youth.
7.3 Target Audiences

The strategy identifies three categories of audiences:
Primary audience: This is the core group of people around whom the strategic communication objectives are focused and within whom the
primary behaviour change is to take place. Adolescents and youth aged between 10 to 24 years old mostly make up this group.
Secondary audience: This group is made up of the people who directly relate to the primary audience through frequent contact and who may
support or inhibit behaviour changes in the primary audience through their influence. These include:
• Parents
• Health workers
• Community volunteers
Tertiary audience: These are individuals in authority, community groups and institutions who may support or inhibit behaviour and social
change in a community. This group has control over local social environment, communication channels and decision making processes and have
a great influence on local social norms. These include:
• DHMT
• Health Facility Advisory Committees
• Traditional leaders
• Faith based leaders
8. STRATEGIC COMMUNICATION FRAMEWORK
Below, table 2 highlights specific behavioural issues and corresponding communication objectives for supporting the overall goal. It also
highlights the key messages for each target audience and the channels used to deliver messages to each.
Table 2: Communication Interventions
Behavioural
issue
Communication
Objectives
Target Audience Messages Channels

1. Most youth
requiring SRH
services do
not seek the
services.
Increase by 10%
the proportion of
youth (by
categories of
boys and girls)
who report
seeking SRH
services by
January 2020.
Primary:
• Girls 10-14
• Girls 15-19
• Girls 20-24
• Boys 10-14
• Boys 15-19
• Boys 20-24
Youth clubs
• SRH services are offered free of charge in all
outlets within the project area.
• SRH services are offered within your community.
• Find out from your community health worker
where to get SRH services.
• SRH service providers are trained to keep client
confidentiality.
• It’s your right to receive SRH services to achieve
your aspirations.
• You can get SRH information from many outlets
including youth clubs, youth friendly health
services centre, radio or community health
workers.
• Do not feel ashamed to seek information-you
are doing something good for yourself.
• Open day incorporated with
sporting events
• Popular dances & drama
• Youth dialogue/debates.
• Promotional
Materials/Brochures
• Community radio
programmes
• Briefing meetings
• Branded T-Shirts
• Sporting bonanza
• Community filming
Secondary:
• Service
providers
• Your attitude has a bearing on how youth access
SRH services.
• Every youth has a right to access SRH services in
a friendly manner.
• It is important to keep confidentiality for clients
including youth.
• Review meetings
• Interface meetings between
youth & service providers
• Training
• Supervisory visit/mentoring.
• Teachers • It is your responsibility to provide SRH
information to learners.
• Talk to your students openly and honestly about
the consequences of unprotected sex and how
they can protect themselves from unwanted
pregnancies and HIV.
• Briefing meeting
• Training

• Parents
• Community
members
(elders,
traditional
counsellors,
cultural
custodians)
Mother groups
Patrons/matro
ns of youth
clubs
• Media houses
• You may not know if your youth is engaging in
sexual activities
• It is your responsibility to provide SRH
information to your youth.
• Contraceptives are important even to unmarried
youth in order to prevent unwanted pregnancies
and maternal complications such as unsafe
abortions, paralysis, fistula and even death.
• Unplanned pregnancy is a risk to the youth. It is
important for youth to access SRH services.
• Community interface
meetings
• Community radio
programmes
• Leaflets
• Interactive drama
• Traditional dances
meetings
• Community radio
programmes
• Leaflets
• Media briefing
Behavioural
issue
Communication
Objectives
Target audience Messages Channels
2. Most sexually
active youth
do not use
contraceptives
The percentage of
adolescents by gender
who report using
modern contraception
increased by 10% in
Primary:
• Girls, 10-14
• Girls 15-19
• Girls 20-24
• SRH services are offered free of charge in all
outlets within the project area.
• SRH services are offered within your
community.
• Find out from your community health worker
sporting event
• Popular dances & interactive
drama
• Youth dialogue/debates

each district by 2020.
The percentage of
youth who are able to
state at least three
benefits of using
contraceptives is
increased by 60% by
2020
Awareness of at least
three FP methods
increased from 65% to
90% by 2020
• Boys, 10-14
• Boys 15-19
• Boys 20-24
• Youth clubs
• Young couples
where to get SRH services.
• SRH service providers are trained to keep
client confidentiality.
• It’s your right to receive SRH services to
achieve your vision
• You can get SRH information from many
outlets including youth clubs, youth friendly
health services centre, radio program or
community health workers.
• Do not feel ashamed to seek information-
you are doing something good for yourself.
• Modern methods are the most effective at
preventing unwanted pregnancies.
• Contraceptives help to prevent unplanned
pregnancy and related maternal
complications such as fistula, unsafe
abortion, paralysis and even early death.
• Your school can not be interrupted due to
unplanned pregnancy if you use
contraceptives.
• FP methods are safe. It’s okay for young girls
to use hormonal methods.
• It only takes one time of unprotected sex to
get HIV, STI or pregnancy.
• Early sexual debut puts an adolescent at risk
of teenage pregnancy, unsafe abortion,
genital deformities and maternal
complications such as fistula and even
death.
• It’s wise to say no to sex.
• Discuss FP as a couple and go to the nearest
facility to find the method that’s right for
you (girls/boys in union).
• Promotional
Materials/Brochures
• Community radio
programmes

Secondary:
• Service
providers
• Teachers
• Parents
• Community
members
(elders,
traditional
counsellors,
cultural
• Your attitude has a bearing on how youth
access SRH services.
• Every youth has a right to access SRH
services in a friendly manner.
• It is important to keep confidentiality for
clients including youth.
information to learners
• Talk to your learners/students openly and
honestly about consequences of
unprotected sex and how they can protect
themselves from unwanted pregnancies and
HIV.
• You may not know if your youth is engaging
in sexual activities.
information to your youth.
• Contraceptives are important even to
unmarried youth in order to prevent
unwanted pregnancies and maternal
complications such as unsafe abortions,
paralysis, fistula and even death.
• Review meetings
• Training
• Supervisory visit/mentoring
• Briefing meeting
• Training
meetings
• Community radio
programmes
• Leaflets
meetings
• Community radio
programmes

custodians)
Mother
groups
Patrons/matro
ns of youth
club
• Media houses
• Unplanned pregnancy is a risk to the youth.
It is important for youth to access SRH
services.
• Getting pregnant too young (before 18) puts
the health of the youth and that of the baby
at risk.
• Leaflets
• Media briefing
• Media tour
Behavioural
issue
Communication
Objectives
3. Some service
providers are
judgmental
toward youth
who come to
seek SRH
services.
The percentage of youth
who report satisfaction
with SRH services
increased from 87% to
95% in all districts by
2020.
Primary:
• Health
workers
(HSAs, YFHS
providers)
• Your attitude has a bearing on how youth
access SRH services.
• Every youth has a right to access SRH services
in a friendly manner.
• It is important to keep confidentiality for
clients including youth.
• Review meetings
• Training
• Supervisory visit/mentoring

Tertiary:
• DHMT
• Health
Facility
Advisory
Committees
• Positive attitude of service providers towards
youth who seek SRH services is necessary in
order to keep youth utilizing the services.
• Adolescents/youth have the right to access
SRH services in a friendly and respectable
manner. Support health workers to provide
SRH services in ethical, youth-friendly
manner.
• Review meetings
• Face to face meetings
Behavioural
issue
Communication
Objectives
4.Some
traditional
initiators use
initiation
ceremony
aspects that
encourage
youth to
engage in
premature and
unprotected
sex.
• To increase by 10%
the number of
traditional initiators
who report teaching
their initiates about
dangers of
unprotected sex and
teenage pregnancies
by 2019.
• Increase by 20% the
proportion of initiates
who report to have
been taught about
dangers of
unprotected sex by
2019.
Primary
• Traditional
initiators
Secondary
• Traditional
leaders
• Parents
/Guardians
• Unprotected sex puts youth at risk of
sexually transmitted infections including
HIV/AIDS and unwanted pregnancies.
• Ensure that dangers of unprotected sex are
discussed with adolescents during
initiation.
• Early/teenage pregnancies put youth at risk
of maternal complications such as fistula,
unsafe abortions, paralysis and even death.
• Reaching puberty does not mean a girl is
ready for sex.
• Even if a teenage girl reaches puberty her
body is physically not ready for child
bearing.
• Sensitization meetings
• Radio program/spot
meetings
• Job aids (Flipchart, fact
sheets, orientation manual,
fliers, etc.)

Behavioural
issue
Communication
Objectives
5.Some
community
members and
parents do not
approve use of
contraceptives
among
unmarried
youth
particularly
girls.
proportion of young
people, who report
being encouraged by
their parents to seek
SRH services by
December, 2018.
proportion of
community members
who speak in favour of
young people who
seek SRH services by
2019
Primary
• Parents
• Community
members
• Youth clubs
Secondary
• Health
workers,
• DHMTs, CBOs
• Religious
leaders
• Traditional
leaders
• mother groups
• VHC, CBOs,
Community
members
• Unplanned pregnancies are risky to youth.
• Youth need SRH information to keep
healthy. Encourage them to seek SRH
services.
• Unmarried youth also need contraceptives
to avoid risky unplanned pregnancies
• Having correct SRH information is
important for proper guidance of youth.
(Parents; mother groups)
• Contraceptives are important even to
unmarried youth in order to prevent
unwanted pregnancies and maternal
complications such as unsafe abortions,
fistula and even death.
• It is important for parents and community
leaders to have SRH information to make
informed decisions on their community
health.
• Parents need correct and adequate SRH
information to guide their youth
• Contraceptives are for anyone within the
reproductive age group including
unmarried youth.
• Open days
meetings
• Trainings
• Job aids (Community SRH
booklet, Flipchart, fact
sheets, fliers, etc)
• Job aid (flipchart, leaflet)

Behavioural
issue
Communication
Objectives
6. Some
parents do
not discuss
SRH issues
with their
adolescents.
• Increase by 50%
the proportion of
adolescent who
report to have
received correct
SRH information
from their parents
by 2019.
• Increase by 50%
the number of
parents who are
able to state at
least three basic
SRH services for
young people by
2019.
• Increase by 40%
the number of
adolescents who
report to have
received parental
encouragement to
attend youth SRH
gatherings
Primary
• Parents
• Adolescents
• Adolescents need SRH information
to make informed decisions and
choices about their reproductive
health. Break the social distance.
Talk to them.
• Having correct SRH information is
important for proper guidance of
youth.
• Youth look up to parents or
guardians for guidance. Discuss
consequences of unprotected sex
and how they can protect
themselves from unwanted
pregnancies and STIs including
HIV.
• If you do not provide adolescent
children with information about
SRH they make uninformed
decisions which may put them at
risk of unwanted pregnancies and
STIs including HIV.
• Youth clubs are an important
source of SRH information.
• It is the responsibility of parents
to provide guidance to children
even on SRH issues.
• Getting pregnant too young (less
than 18 years) puts youth at risk
of maternal complications such as
unsafe abortion, paralysis, fistula
and even death.
• Open days
• Community interface meetings
• Trainings
• Job aids (Community SRH booklet,
Flipchart, fact sheets, fliers, etc)
• School health talks
• Debates
• Youth open day (question & answer

Secondary
• Media houses
• Seek guidance from your parents
on how to prevent pregnancy.
• It is important for parents and
community leaders to have SRH
information to make informed
decisions on their community
health.
• The future of a community
depends on health youth.
Encourage parents to guidance to
youth on SRH issues.
time, drama performances,
storytelling)
• Promotional materials (T-shirts, caps,
bandanas, branded wrist bands, etc)
• Meetings
• Media orientation meeting.
• Advocacy meetings
Behavioural
issue
Communication
Objectives
7. Some
community
leaders do not
approve use
of
contraceptives
among
unmarried
youth
particularly
girls for 10-19
year olds.
• Increase by 30%
the proportion of
community leaders
who report
speaking openly in
support of
contraceptive use
among the
unmarried youth by
2020.
Primary:
(TAs, GHVs, VHs)
• Faith based leaders
• Media
• Young people do become pregnant
when they stop using
contraceptives when they desire to
have children.
• Some young people have used
contraceptives and have been able
to bear children after stopping
using contraceptives.
• Brochures
• Fact sheets
sporting events
• Media briefing
• Media awards

• By 2020 60% of
community
members will
report to have
heard community
leaders talking in
support of
contraceptive use
among the youth.
Secondary:
• District Council
Health &
environment sub-
committee
• People using contraceptives need
to avoid risky sexual behaviours to
avoid STIs including HIV and AIDS.
• Brochures
• Fact sheets
Behavioural
issue
Communication
Objectives
Target Audience Messages Channels
8.Most
unmarried
youth shun
long-acting
and
reversible
contraceptiv
es (LARCs).
• By 2020 10% of
youth who sought
modern
contraceptives will
report seeking
long acting and
reversible
contraceptives.
• By 2020 10% of
youth should
report using long
acting and
reversible
contraceptives.
Primary:
• Unmarried Youth
aged 10-19
Secondary:
• Parents,
Community
Leaders, Youth
Organizations,
CBOs, Mother
Groups, Media
• Long acting and reversible
contraceptives are safe for
everyone including youth.
• Young people do become pregnant
when they stop using
contraceptives when they desire to
have children.
• Long acting and reversible
contraceptives give young people
peace of mind to finish their
education.
• Dialogue/debates
• Youth interface meetings
sporting event
• Popular dances & interactive drama
• Youth dialogue/debates
• Promotional Materials/Brochures
• Community radio programmes
• Modern media (what up groups,
facebook, twitter, instagram, etc).

• By 2020 70% of
young people
should mention at
least three
advantages of
LARCs over other
comprehensives.
• Community interface meetings
• Media briefing
9. MONITORING AND EVALUATION
Monitoring is essential to understanding if SRH communication activities are being implemented as planned and to determine if adjustments are
needed. Evaluation is important for measuring the success of the activities and for understanding the contribution to increased SRH services
uptake – decreased teenage pregnancies, unsafe abortions and sexually transmitted infections.
Routine monitoring of the EC-SRH project communication strategy implementation will be done through the HMIS data. Other data not included
within the HIMS will be captured through operational research. Review meetings will also be conducted periodically to further inform the
direction and outcomes of communication interventions.
Evaluation of the communication strategy will be done through midterm and end of project reviews.
9.1 Monitoring and evaluation indicators
The following indicators will be applied when monitoring and evaluating this communication strategy:
• Number/proportion of youth (by categories of boys and girls) who report seeking SRH services.
• Percentage of adolescents by gender who report using modern contraception.
• Percentage of youth who are able to state at least three benefits of using contraceptives.
• Number/proportion of youth who are able to mention at least three FP methods.
• Percentage of youth who report satisfaction with SRH services.
• Number of traditional initiators who report teaching their initiates about dangers of unprotected sex and teenage pregnancies.
• Number/proportion of initiates who report having been taught about dangers of unprotected sex.
• Proportion of young people who report being encouraged by their parents to seek SRH services.

• Number/proportion of community members who report speaking in favour of young people who seek SRH services.
• Number/proportion of adolescent who report to have received SRH information from their parents.
• Number/proportion of parents who are able to state at least three basic SRH services for young people.
• Number/proportion of adolescents who report to have received parental encouragement to attend youth SRH gatherings.
• Number/proportion of community leaders who report speaking openly in support of contraceptive use among the unmarried youth.
• Number/proportion of community members who report to have heard community leaders talking in support of contraceptive use among
the youth.
• Number/proportion of youth who report seeking long acting and reversible contraceptives.
• Number/proportion of youth who report using long acting and reversible contraceptives.
• Number/proportion of young people who are able to mention at least 3 advantages of LARCs over other comprehensives.
• Proportion of women aged 15 to 24 years old with unmet need for family planning
• Contraceptive prevalence rate for women aged 15 to 49 years old (disaggregated by age, sex and method).
• Number/proportion of youth 15 to 24 years old who accessed SRH services and were referred to/access HIV services.
• Number/proportion of young people (10 to 24 years old) that are aware of at least one service delivery points to access modern SRH
services.
10. PARTNERSHIPS FOR SEXUAL AND REPRODUCTIVE HEALTH
10.1 Role of Key Stakeholders
Relevant Ministries and Reproductive Health Program
The Ministry of Health will provide both policy and strategic direction in implementing the strategy at all levels. Other ministries and
departments working in the project areas will be engaged throughout the implementation process and will have the opportunity to utilise the
identified activities and key messages.
Donors, Development Agencies and Implementing Partners

Bilateral, multi-lateral and other donor organizations may use this strategy and its key activities/messaging to inform future programming of
adolescent sexual reproductive health.
Stake Holders
Stakeholders such as CBOs, traditional and faith based leaders, youth clubs and male motivators will be involved in mobilizing communities,
facilitating communication activities and providing on-going support throughout this programme.
11. COSTED IMPLEMENTATION PLAN 2016-2020
A. EC SRH COMMUNICATION PLAN
TARGET AUDIENCE ACTIVITY INDICATOR TARGETS /
MILESTONE
BUDGET
(EUROs)
TIMELINE OFFICER
RESPONSIBLE
YEAR 1 YEAR 2 YEAR 3
• Girls, 10-14
• Girls 15-19
• Girls 20-24
• Boys, 10-14
• Boys 15-19
• Boys 20-24
• Youth clubs
Conduct messaging &
materials workshops
# of sessions
conducted
2 10,000 X X X PM
Pre-test promotional
materials (mass media
including print)
# of pre-
testing
sessions
conducted
2 3,000 X X X PM

MILESTONE
BUDGET
(EUROs)
TIMELINE OFFICER
RESPONSIBLE
Produce branded T-
shirts
# of T-shirts
produced
3000 10000 X X PM
Produce Promotional
Materials (mass media
including print)
# of
promotional
materials
produced
2 leaflets X
3000
5 posters X
3000
2 stickers X
1500
2 banners X
10
1Communit
y billboard
X 50
10,000 X X PM
Develop SRH job aids
for parents
# of job aids
produced
2 flip charts
X 1000
3000 X PM
Conduct SRH talks in
schools
# of schools
reached with
SRH talks
300 schools 1500 X x x x x x x x District
Coordinators

MILESTONE
BUDGET
(EUROs)
TIMELINE OFFICER
RESPONSIBLE
Pilot use social media
to disseminate SRH
messages such as
WhatsApp, Facebook
# of social
media fora
created
# of youth
reached with
messages
through social
media
1 social
media
forum per
district
50
youth/distri
ct
2000 X X PM
Procure mobile phones
for social media
network
# of phones
procured
50 1000 X PM
Register youth for
social media
networking
# of youth
registered
50/district 1000 X District
Coordinators
Conduct open days
incorporated with
sporting
events/bonanza
# of open days
conducted
80 open
days
30,000 X X X X X X X X X District
Coordinators

MILESTONE
BUDGET
(EUROs)
TIMELINE OFFICER
RESPONSIBLE
Service providers
Conduct youth
dialogue/debates
sessions
# of sessions
conducted
1200
sessions
1500 x x x x x x Community
facilitators
Conduct community
radio programmes
# of radio
programmes
aired
2 X 48
programme
s
1000 x x x x x PM
Produce and air radio
spots
# of radio
spots
produced and
aired
16 spots
16 X 12
airing
sessions
1500 x x x x x PM
Produce video
documentaries
# of video
documentarie
s produced
1 video
documenta
ry
1500 X X PM
Conduct community
filming
# of film
shows
200 film
shows
X x x x x x x x District
Coordinators
Conduct briefing
meetings with health
workers and support
staff on customer care
# of health
workers
briefed
580 health
workers
1000 X x CHAM
Coordinator
Conduct quarterly
health centre review
meetings
# of review
meetings
conducted
454
meetings
6000 X x x x x x CHAM &
KCN

MILESTONE
BUDGET
(EUROs)
TIMELINE OFFICER
RESPONSIBLE
Teachers,
Patrons/matrons of
youth clubs
Conduct youth-service
providers interface
meetings
# of sessions
conducted
116
sessions
3000 x x x District
Coordinators
Conduct mentoring of
health workers on SRH
communication
through supervisory
visits
# of visits
conducted
454 visits 2000 x x x x x CHAM $ KCN
Conduct SRH review
meetings
# of sessions
conducted
8 sessions 8000 X x x MEAL
Coordinator
Train teachers on
adolescent SRH and
life skills
# of teachers
trained
330 10000 X District
Coordinators
Train patrons and
matrons
# of Patrons
and matrons
trained
400 7200 x x x Community
facilitators
Develop job aids for
parents capacity
building
# of working
sessions
conducted
# of job aids
developed
3 sessions 1000 x x PM

MILESTONE
BUDGET
(EUROs)
TIMELINE OFFICER
RESPONSIBLE
Parents, Community
members (elders
Produce parents –child
communication job
aids
# of job aids
produced
# of types of
job aids
produced
1 2000 X x PM
Pre-test Parents job
aids
# of job aids
pretested
# of types of
job aids
pretested
1 1000 x PM
Conduct community
interface meetings
# of sessions
conducted
# of
community
members
who attend
each session
100 2000 x x x x x x x Community
Facilitators

MILESTONE
BUDGET
(EUROs)
TIMELINE OFFICER
RESPONSIBLE
Traditional
initiators/counsellors
Train community
drama groups in
interactive drama skills
focusing on SRH.
# of drama
groups trained
# of training
sessions
conducted
25 10000 X X PM
Conduct SRH
Interactive drama
sessions in
communities
# of drama
performances
conducted
# of
community
members
reached with
drama
sessions
500 65000 X x x x x x x x District
Coordinators
Develop youth
initiators manuals
Developed
Manual
1 500 X PM

MILESTONE
BUDGET
(EUROs)
TIMELINE OFFICER
RESPONSIBLE
Print youth initiators
manual
# of copies of
manual
printed
500 copies 1000 X X X X X X X PM
Conduct SRH
sensitization meetings
with traditional
initiators/counsellors
# of sessions
conducted
# of initiators
sensitised.
15
500
3000 X x x x x x x Community
Facilitators
Mother groups Conduct SRH
with mother groups
# of
sensitisation
meetings
conducted
# of mother
group
members
sensitised.
200 2000 X X X X X X X Community
facilitators
Traditional leaders Conduct SRH
with traditional leaders
# of
sensitisation
meetings
conducted
# of
300 2000 X X X Community
Facilitators

MILESTONE
BUDGET
(EUROs)
TIMELINE OFFICER
RESPONSIBLE
traditional
leaders
sensitised
DHMTs Conduct advocacy
meetings with DHMTs
on youth SRH service
issues
# of sessions
conducted
# of DHMTs
reached.
15 1500 X X X District
Coordinators
CBOs Conduct SRH
sensitization
# of CBOs
sensitized
50 2000 X District
Coordinators
Religious leaders Conduct SRH
sensitization
# of
sensitisation
meetings
# of religious
members
reached.
200 2000 X X X Community
facilitators

MILESTONE
BUDGET
(EUROs)
TIMELINE OFFICER
RESPONSIBLE
Media
personnel/houses
Conduct youth SRH
media tour
# of media
tours
conducted
3 1000 X X X PM/Senior
Manager
Communicat
ion
Conduct SRH media
briefing sessions
# of media
briefings
conducted
3 1000 x x x PM
Conduct sporting
bonanza
# of sessions
of sporting
bonanza
conducted
# of youth
patronising
sporting
bonanza.
10
50,000
10,000 X x x x x x District
Coordinators
12. APPENDICES
I. EC: SRH | Evidence Based Strategy Matrix..............DocumentsEC SRH ProjectEvidence based strategy developmentMatrix for
Evidence Based Strategy Development_jlk.docx

13. REFERENCES
I. Preliminary Perspective Barrier Survey Report, 2015, Kamuzu College of Nursing
II. Baseline Survey Report of Save the Children EC SRH Project, 2015
III. SSDI- communication, Findings from the 2012 Baseline Survey of 15 Districts in Malawi. USAID, SSDI-Communication.
IV. Malawi Demographic Health Survey, 2010
V. Malawi Demographic Health survey, 2015-2016
VI. MDG Endline survey, 2014
VII. Malawi Expanded Programme of Immunization Strategy
VIII. Malawi Health Promotion Communication Strategy
IX. Malawi health Sector Strategic Plan 2011-2016

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