Field Assessment of Emergency 
Plan Centrally-Funded HIV 
Prevention Programs for Youth 
This document was made possible by support from the U.S. President's Emergency Plan for 
AIDS Relief and the U.S. Agency for International Development (USAID) under terms of 
Cooperative Agreement GPO-A-00-03-00003-00. The authors’ views expressed in this document 
do not necessarily reflect the views of USAID or the United States government. 
March 2007 SR-07-34 
ii
Acknowledgments
This report was written by Ilene Speizer and Carla Lopez of the MEASURE Evaluation project 
based at the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. The authors 
would like to thank Leah Wanjama and all of the ABY partners who gave their time to 
participate in the site visits in Haiti, Kenya, Mozambique, Ethiopia, and Tanzania. 
MEASURE Evaluation 
Carolina Population Center 
University of North Carolina at Chapel Hill 
206 W. Franklin St., CB8120 
Chapel Hill, NC 27516 USA 
Telephone: 919-966-7482 
http:www.cpc.unc.edu/measure/ 
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Table of Contents 
Executive Summary .......................................................................................................................1 
Background................................................................................................................................. 1 
Methods ...................................................................................................................................... 1 
Findings ...................................................................................................................................... 1 
Recommendations ...................................................................................................................... 2 
Conclusions ................................................................................................................................ 3 
1. Introduction ................................................................................................................................4 
2. Methods .....................................................................................................................................5 
2.1 Developing a Framework to Assess ABY Programs ............................................................. 5 
2.2 What the Literature Says about High Quality ABY Programming.......................................... 7 
2.3 Pilot Site Visits ...................................................................................................................... 8 
2.4 Expert Consultation Meeting ................................................................................................. 8 
2.5 Methods of Field Study ......................................................................................................... 9 
2.6 Limitations of Process Evaluation ....................................................................................... 10 
3. Observations and Recommendations from the Quality Assessment...........................................11 
3.1 Summary of Partners Visited and Programmatic Strategies ............................................... 11 
3.2 What Does the ABC Guidance Say about ABY Programming? .......................................... 12 
3.3 Program Environment ......................................................................................................... 13 
3.4 Involvement of Church and Community .............................................................................. 14 
3.5 Program Coordination......................................................................................................... 14 
3.6 Program Settings ................................................................................................................ 16 
3.7 Curricula-Based Programs.................................................................................................. 19 
3.8 Peer Education ................................................................................................................... 22 
3.9 Adult-Led Programs ............................................................................................................ 26 
3.10 Community Interaction ...................................................................................................... 26 
3.11 Mass Media....................................................................................................................... 28 
3.12 Parent and Caregiver Programs ....................................................................................... 28 
3.13 Training of Trainers and Messengers................................................................................ 29 
3.14 Program Reach................................................................................................................. 31 
3.15 Observations from Visits with the Same ABY Partner in Multiple Countries ..................... 31 
3.16 Gaps Identified in Existing ABY Programs........................................................................ 32 
4. Conclusions .............................................................................................................................33
5. Next Steps ...............................................................................................................................34 
6. References...............................................................................................................................36 
7. Bibliography of Selected Additional Resources Used for Tool Development ...............................37 
Appendix A. List of Recommendations..........................................................................................41 
Appendix B. Countries Where ABY Partners Are Supported to Work .............................................43 
Appendix C. Participants in Expert Meeting...................................................................................45 
Appendix D. Summary of ABY Expert Consultation Meeting, June 5-6, 2006 .................................46 
Appendix E. Assessment Tool of Youth Reproductive Health Programs.........................................48 
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1
Executive Summary 
Background 
In an effort to mitigate the spread of HIV among youth in developing nations, the U.S. 
President’s Emergency Plan for AIDS Relief (Emergency Plan), through the U.S. Agency for 
International Development (USAID), funded 14 faith-based and nongovernmental organizations 
in 2004 and 2005 to carry out multi-country HIV prevention programs that have as their primary 
objective the promotion of abstinence until marriage, fidelity in marriage and sexual 
relationships, and avoidance of unhealthy sexual behaviors among youth aged 10-24. (For 
brevity purposes, these abstinence and fidelity in marriage programs are called ABY programs, 
which refers to the widely-used descriptive phrase: “abstinence and be faithful for youth.”) 
In 2006, to assess and improve the quality of these centrally-funded, multi-country ABY 
programs, USAID requested that the MEASURE Evaluation project carry out an evaluation of 
these partners’ program activities. The evaluation was divided into two phases: a process 
evaluation phase (Phase I) and an outcome evaluation phase (Phase II). The primary focus of 
Phase I was to produce information useful for making recommendations for “mid-course 
corrections” to the ABY programs to help maximize their potential benefits. This Phase I report 
provides an assessment of the quality and rigor of centrally-funded ABY partner programs and 
overall recommendations for strengthening these and other abstinence and partner reduction 
programs for youth. 
Methods 
To determine the characteristics of higher quality programs, the MEASURE Evaluation team 
collected published and unpublished information on youth programming and consulted with 
youth programming experts. Based on the information collected, the evaluation team was able to 
create a process evaluation tool for use in the field. In May 2006, the MEASURE Evaluation 
team visited Haiti to pilot test the process evaluation tool with three ABY partners. Between June 
and July 2006, the MEASURE Evaluation team conducted site visits in Kenya, Tanzania, 
Mozambique, and Ethiopia. A total of 20 site visits with 13 ABY partners were conducted in the 
five countries. During each site visit, the evaluation team first met with project managers to gain 
a thorough understanding of how programs were developed, implemented, and managed. The 
evaluation team then met with trainers, peer educators, and other field staff to get their 
perspectives on the activities with which they were involved. Based on these discussions and 
using the evaluation tool, the team was able to identify the strengths of each program, as well as 
make recommendations for program improvement. 
Findings 
The 20 site visits undertaken as part of the field assessment of centrally-funded ABY programs 
revealed a number of strengths and weaknesses of the programs. In terms of project design, the 
stronger program sites: 
• undertook formative work prior to receiving the funding; 
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• had prior experience with youth AB programming that could be applied in the 
nascent stages of the project; and/or 
• had a clear programmatic framework that informed the project design and 
implementation. 
Notably, weaker programs lacked structure and were more focused on attaining Emergency Plan 
targets than on undertaking high quality programming with target youth. Visits with the same 
organization in multiple countries indicated the importance of strong leadership, either from the 
central office or across countries where the program was underway. Where the leadership was 
strong and worked across countries, the approach was standardized across locations. Conversely, 
where the leadership was weaker or the programs were managed by separate country offices, the 
program was less consistent across locations. Similarly, programs that were implemented solely 
by the ABY partner tended to be consistently implemented within a country; whereas when the 
lead organization partnered with other organizations, the program risked being more disparate. 
Successful partnering strategies were observed and, in these cases, all partner organizations 
undertook joint training and a common curriculum/approach was used by all partners. 
While all but one of the programs visited would be considered curriculum-based programs, there 
was variability observed in the content of the curricula, the depth of the messages, and the use of 
skills-based training. Moreover, some of the curricula had yet to be translated into local 
languages and, in many cases, facilitators did not receive a copy of the curriculum to help them 
facilitate sessions with their target groups. A particular gap identified in the curricula used by the 
ABY partners was a lack of specific messages and skills-based lessons on partner reduction and 
mutual fidelity. One ABY partner has recently developed four lessons on this topic and on other 
high-risk sexual behaviors. These materials could be shared with other ABY partners to help fill 
this gap. 
While all but one of the programs visited used peer educators as program facilitators, about half 
also implemented the program using adult facilitators (teachers, scout leaders, or trainers). 
Project facilitators (peer educators or adult facilitators) were always trained; however, the 
duration and quality of the training varied across the partners. Stronger programs undertook a 
formal training and had training materials, such as a training manual or facilitator’s guide. 
Weaker programs undertook an orientation that was a shortened version of training, with no 
formal training materials. Likewise, while all organizations supervised their peer educators, some 
organizations were doing this more effectively than others. 
Recommendations 
Based on the 20 site visits, a number of recommendations were identified for the design and 
development of future ABY programs or for the strengthening of current ABY programs. Some 
of these recommendations are cross-cutting (i.e., not specific to a type of approach), while others 
are specific to the type of approach (e.g., curriculum-based, peer education, etc.). 
A summary of all recommendations and observations is found in Appendix A. The main cross￾cutting recommendations for designing or improving ABY programs include the following: 
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• Use a clear programmatic framework that specifies how resources are applied 
to activities with key populations to achieve outcomes and potential impacts 
(a logic model) at the planning phase to ensure that program strategies are 
directly related to program goals and objectives. 
• Conduct a needs assessment to improve the relevance and potential impact of 
the program activities. 
• Secure community buy-in for program activities. 
Managers of ABY programs that are already underway without a logic model or needs 
assessment should consider undertaking these activities to help strengthen their programs. In 
particular, the development of a logic model can help identify gaps in program design and areas 
that should receive greater emphasis. Likewise, collecting data at the community level can help 
to determine whether the program is meeting the community needs and strategies for adaptation. 
The remaining recommendations were specific to ABY programmatic strategies being 
undertaken. The evaluation team made a number of recommendations for curriculum-based 
programs, peer education programs, adult-led programs, community-interaction programs, and 
parent and child caregiver programs. These recommendations focused on the need for high￾quality training of facilitators (peer educators, teachers, and trainers), supervision and monitoring 
of facilitators, and strategies to ensure that the program is implemented in a standardized manner. 
Standardization of curricula and training ensures that the program is implemented appropriately 
and that information and skills relayed are approved by the ABY implementing organization. 
Conclusions 
This report is meant to help ABY partners to strengthen their programs by describing the 
strengths and challenges of a variety of programs. The report and attached assessment tool 
(Appendix E) can also be used by funders, program planners, and program managers who want 
to identify the characteristics of stronger ABY programs. The observations and recommendations 
from this report are similar to what has been found in the literature on HIV prevention programs 
and are likely generalizable to youth HIV prevention programming more broadly. 
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Report Objective 
The objective of this report is to indicate when 
and how high quality ABY programming is taking 
place, but also to indicate gaps in ABY 
programming that could be improved through 
adoption of some of the key elements of effective 
program strategies. 
In some cases, gaps identified were consistent 
across a number of the programs visited; 
whereas in other cases, gaps identified were 
specific to a program or site visited. 
1. Introduction 
In late 2003 and early 2004, the U.S. Agency for International Development (USAID) released 
two Annual Program Statements (APS) that solicited applications from organizations to expand 
activities in support of abstinence until marriage, fidelity in marriage and sexual relationships, 
and avoidance of unhealthy sexual behaviors among youth aged 10-24. The solicitations 
specifically supported the following evidence-based strategic approaches: scaling-up of skills￾based HIV prevention education, especially for younger youth and girls; stimulating broad 
community discourse on healthy norms and avoidance of risk behaviors; reinforcing protective 
influences of parents and other primary caregivers; addressing sexual coercion and exploitation 
of young people; and strengthening early prevention interventions for at-risk youth. 
Based on the responses to these solicitations, 14 nongovernmental organizations (NGOs) and 
faith-based organizations (FBOs) were awarded direct funding from USAID Washington to 
significantly scale up international youth HIV prevention activities that support abstinence and 
fidelity in marriage strategies. Each organization was required to work in at least two countries, 
and on average, each organization is working in about three or four of the 15 President’s 
Emergency Plan for AIDS Relief (Emergency Plan) focus countries (see Appendix B for a list of 
each partner and the countries where they are working). Across the funded organizations, 
activities are underway in 14 out of 15 of the Emergency Plan focus countries. [For brevity 
purposes, these abstinence and fidelity in marriage programs are called ABY programs, which 
refers to the widely-used descriptive phrase: “abstinence and be faithful for youth.”] 
To ensure the quality of implementation and 
maximize the potential impact of these 
activities, in 2006 USAID requested 
MEASURE Evaluation to undertake a targeted 
evaluation of the ABY programs. The 
evaluation was divided into two phases: a 
process evaluation phase (Phase I) and an 
outcome evaluation phase (Phase II). The 
primary focus of Phase I was to produce 
information useful for making “mid-course 
corrections recommendations” to the ABY 
programs to help maximize their potential 
benefits. This Phase I report provides an 
assessment of the quality and rigor of centrally 
funded ABY partner programs and overall 
recommendations for strengthening these and 
other abstinence and partner reduction 
programs for youth. 
For Phase I, we developed and applied methods to characterize quality in terms of the strength, 
rigor, and sustainability of funded ABY activities. The determination of quality and 
recommendations for program improvement were based on information on factors associated 
with more effective youth reproductive health programs from both published and unpublished 
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sources. The assessment focused on the inputs, processes, and outputs of the ABY activities. 
The information on ABY programs is based on 20 site visits with 13 of the 141
 centrally-funded 
partners in five countries. Two ABY partners were observed in three countries, three ABY 
partners were visited in two countries, and the remaining eight ABY partners were visited in one 
country. Visits with the same partner in multiple countries provided a perspective of how some 
programs vary from one context to another. Details on which partners were visited in each 
country are presented in Table 1. 
Table 1. Site Visit Countries and ABY Partners Visited in Each Country 
Haiti* Kenya Mozambique Ethiopia Tanzania 
ADRA X X 
American Red Cross X X 
Catholic Relief Services X 
Fresh Ministries X 
Food for the Hungry X 
Hope Worldwide X 
International Youth Foundation X 
PACT X 
PATH X 
Salesian Missions X 
Samaritan’s Purse X X 
World Relief X X X 
World Vision X X X 
Shaded cells indicate that partners are working in these countries, but the programs were not visited by MEASURE 
Evaluation team. 
* Haiti was used to pilot test the site visit assessment tool. 
2. Methods 
2.1 Developing a Framework to Assess ABY Programs 
In March 2006, the MEASURE Evaluation project team met with the ABY partners to introduce 
the process and outcome evaluations. Initial visits were conducted with the headquarters offices 
of the ABY partners either in person or by telephone, depending on the location of the 
headquarters office and availability of headquarters project managers. Through these visits and a 
review of ABY project work plans, MEASURE Evaluation uncovered an extensive list of 
program strategies proposed and under way in the field. 
Following the introductory visits, MEASURE Evaluation comprehensively reviewed published 
and unpublished information on youth programming. This review included searching for 
documents on youth; reproductive health; HIV prevention; peer education; curriculum-based 
 
1
 One partner that received funding in 2006 was not visited in the field because the program was too new to be able 
to provide details on program implementation. 
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programs; abstinence programs; faithfulness programs; abstinence, be faithful, and correct and 
consistent condom use (ABC) programs; community mobilization; mass media; and school￾based programs. Characteristics of strong programs were identified in discussions of 
implementation issues, best practices, lessons-learned, or evaluation findings. The review of the 
ABY partner strategies and the available literature indicated the need to obtain information on 
five main areas: 
• program environment – organizational preparedness and program 
coordination 
• community and church involvement 
• program setting – school, church, community 
• program characteristics – design and development of program, content of 
program, characteristics of the curriculum used, delivery mechanisms, and 
training of implementers of the program 
• strategies – adult-led; peer education; mass media; community mobilization; 
and parent/child communication 
In the framework below (Figure 1), we indicate how these five areas impact one another and lead 
to program outcomes for beneficiaries. In the discussion of the findings, we provide observations 
from the field on what ABY-funded partners were doing in key areas, and how changes could be 
made to strengthen the programs observed with an eye toward evidence-based programming. 
The framework below indicates the distinction between program participants and the 
beneficiaries. In some cases, these are the same youth (e.g., in mass events) whereas in other 
cases, the participants are the peer educators or their small target group but the beneficiaries are 
all youth in the community in which the participants reside. 
Figure 1. Conceptual framework of factors that influence program quality in terms of 
strength, rigor, and sustainability. 
Organizational 
Environment 
Community/ 
Church 
Involvement 
Design & 
Development 
Content 
Curriculum 
Delivery 
Training of 
Trainers 
Adult-Led 
(scouts, 
school-based, 
parish) 
Peer Education 
Mass Media 
Parent-Child 
Community 
Interaction 
Youth 
• 10-14 
• 15-24 
• Married 
Parents & 
Caregivers 
Community 
Leaders 
High-risk 
• OVC 
• Out-of-School 
• Sexually 
Active 
• Adult Men 
Program 
Setting 
Youth ages 
10-24 
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2.2 What the Literature Says about High Quality ABY Programming 
Two recent reviews of adolescent reproductive health programs provide information on factors 
that should be considered at the program design and development stage. In particular, a review of 
evaluation studies on youth reproductive health programs in developing countries (Speizer, 
Magnani, Colvin, 2003) demonstrates the need to undertake multi-component programs that 
address all three of the main goals of youth programs: providing a safe and supportive 
environment for youth; increasing youth knowledge, attitudes, intentions, skills, and behaviors; 
and increasing youth use of health services. Programs that focus on one goal or another will be 
less successful in meeting the needs of the target 
audience. 
A review of curriculum-based programs by 
Senderowitz and Kirby (2006) and based earlier work 
by Kirby (Kirby, 2001; Kirby, Rolleri, Wilson, 2006), 
identifies 24 standards of effective curriculum-based 
programs for youth reproductive health. These 
characteristics are reflected in the framework (Figure 
1), mostly under the “Program Characteristics” block. 
The standards can be broadly grouped into three 
categories: design and development issues; content of 
the curriculum; and implementation characteristics. 
The components of each category are presented in 
Table 2. The constructs in the design and 
development category are interrelated, since 
programs that identify the specific needs of the target 
audience, design a program accordingly, and use a 
detailed logic model are better able to ensure that the 
program is responsive to community needs and 
consistent with community values. In this report, a 
logic model is being referred to as a programmatic 
framework that demonstrates the interrelations among 
project inputs, outputs, outcomes, and potential 
impacts. 
Curriculum characteristics found by Senderowitz and 
Kirby (2006) to be associated with higher quality 
programs include: focusing on clear health goals 
(HIV/STI prevention and/or pregnancy prevention) 
and behaviors, addressing multiple risk and protective 
factors, creating a safe social environment, including 
multiple activities, using skills-based teaching 
methods, employing activities appropriate for the 
culture and age, addressing gender issues, and 
presenting information that is scientifically and 
medically accurate. These curriculum-based issues 
relate directly to having and using a logic model for 
Table 2. Twenty-four Standards for 
Effective Curricula-Based 
Programs 
Design and Development 
Involve stakeholders 
Assess needs and assets of population 
Use a logic model 
Consider community values and norms 
Consider resources 
Pilot test program 
Content of Curriculum 
Focus on clear health goals 
Focus on specific behaviors that affect goals 
Address multiple risk and protective factors 
Create a safe social environment 
Include multiple activities 
Use skills-based teaching methods 
Employ activities appropriate for the youths’ 
culture, developmental age, and sexual 
experience 
Cover topics in a logical sequence 
Address gender issues 
Present medically and scientifically correct 
information 
Implementation 
Secure support from appropriate authorities 
Select educators with desired characteristics 
Provide high quality training to educators 
Supervise and mentor educators 
If needed, recruit and retain youth 
Implement all activities with fidelity 
Establish monitoring & evaluation for 
program improvement 
Plan for long-term follow-up to ensure 
lasting behavior change 
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program design and development. This ensures that the project messages and strategies are able 
to attain desired program outcomes. Finally, implementation characteristics found to be 
associated with higher quality programming include: having support from appropriate 
authorities; selecting, training, supervising, and mentoring participating educators; implementing 
activities to recruit and retain youth; and implementing activities with fidelity. The 24 standards 
for curriculum-based programs were included on the assessment tool developed for the site visits 
and assessed for each type of program strategy that used a curriculum (assessment tool attached 
in Appendix E). 
Summary reports on strategies for effective youth programming from multiple organizations also 
contributed to tool development. Some particularly useful resources were the Y-PEER Standards 
for Peer Education Programmes, recent YouthNet reports and publications on youth 
programming, the FOCUS on Young Adults Project reports and key element papers, and the 
recent WHO technical report on HIV/AIDS prevention programs for youth (FHI/YouthNet and 
Y-PEER, 2005; Ross, Dick, Ferguson, 2006). Additional resources reviewed for tool creation 
were evaluation studies and program reports of comprehensive reproductive health or abstinence 
programs for youth (see bibliography for a list of resources). 
2.3 Pilot Site Visits 
Based on the literature review and development of the conceptual framework above, a site visit 
tool was developed to ensure that comprehensive information was obtained from each partner 
visited. In May 2006, the site visit tool was pilot tested in Haiti by Dr. Ilene Speizer of the 
MEASURE Evaluation project to determine the feasibility of obtaining structured information on 
ABY program implementation. Haiti was selected for the pilot test of the site visit tool because 
of its proximity to the United States and the fact that two of the partners working there were 
among the original organizations to be funded, and thus had programs that were more established 
than some of the other partners. This provided an opportunity to understand better the program 
implementation characteristics and strategies for program strengthening among existing 
programs. In addition, the third partner visited in Haiti was still in the program design phase, 
which provided a perspective of how the information obtained could be used to strengthen 
program planning as well. With the three partners visited, the draft tool was used; however, 
questions that were not applicable or irrelevant because the program was still being designed 
were not asked. 
The pilot test information was used to make recommendations that would strengthen the three 
visited ABY partners, as well as to provide input on the site visit tool for discussion at an expert 
consultation. In particular, it became clear following the pilot site visits that it was necessary to 
think carefully how to formulate questions so that they are useful for gleaning more than yes/no 
responses and could be used for determining strategies for program improvement. This meant 
that each question needed to be a yes/no type question with a write-in section for each question 
to provide greater depth on each issue. 
2.4 Expert Consultation Meeting 
The final preparatory activity of Phase I was an expert consultation meeting held June 5-6, 2006. 
About 50 people attended the first day of the meeting, including 20 youth programming experts, 
9
20 persons from the centrally-funded ABY partner organizations, and 10 persons from USAID or 
other U.S. government agencies (see Appendix C for a list of participants and Appendix D for a 
summary of the meeting). Following brief background presentations on the ABY strategy and a 
summary report from the site visits in Haiti on the ease and difficulties of obtaining information 
on program implementation, the meeting was conducted in an interactive and dynamic mode to 
obtain input from all participants attending. The objective of the first day of the meeting was to 
determine the characteristics of higher quality youth programs as well as the type of information 
to be obtained during site visits to ensure that program quality could be assessed. Small groups 
were formed around the different strategies and program environment issues to ensure 
comprehensive discussions. The output of the first day of the meeting was to formulate a full list 
of the type of information to collect in site visits. This list was subsequently compared to the 
comprehensive pilot test tool used in Haiti and missing items were incorporated into the final 
version of the tool. 
The second day of the expert consultation meeting involved only the 20 experts in youth 
programming. This was meant to be an opportunity to define specifically which of the 
characteristics reflected higher quality programming. One important outcome of this session was 
the recognition that one-day site visits will yield only minimal information; future visits would 
need to consider a greater depth of program implementation characteristics. For example, follow￾up site visits would be needed to observe direct interactions between trainers and messengers 
(e.g., teachers or peer educators) and between the trained messengers and their youth 
beneficiaries. MEASURE Evaluation, with input from USAID, decided not to undertake direct 
observations as part of the process evaluation because this would mean a longer period of 
fieldwork, and that program strengthening recommendations would be delayed. In addition, it 
was felt that without developing rapport with the groups, the interactions that would be observed 
would not necessarily represent the true interactions between messengers and beneficiaries. 
2.5 Methods of Field Study 
Site visits with ABY partners took place from June 26, 2006 to July 31, 2006 in Kenya, 
Mozambique, Ethiopia, and Tanzania. The research team included Dr. Ilene Speizer, the project 
lead; Carla Lopez, a graduate student at the University of North Carolina School of Public 
Health; and Dr. Leah Wanjama, a faculty member at Kenyatta University serving as a consultant 
on this project. The team undertook seven site visits in Kenya, four site visits in Mozambique, 
two site visits in Ethiopia, and four site visits in Tanzania. This report presents findings from the 
site visits, with an emphasis on program strategies currently being implemented. There is less 
emphasis on strategies that were still under development, such as parent/caregiver programs and 
mass media programs. In addition, while some ABY project sites visited had complementary 
program activities focusing on reduction of stigma against people living with HIV/AIDS, and 
HIV counseling and testing, these activities were documented but were not the focus of the ABY 
evaluation team’s work unless they were being undertaken as part of the ABY grant. 
Prior to the site visits, each ABY partner was contacted in the countries the evaluators intended 
to visit and asked to plan for a day-long meeting with the evaluators. The objective was to spend 
the morning — usually four to five hours (8 a.m. to 1 p.m.) — with project management, 
evaluators, and key program staff. The morning session was an opportunity to obtain depth on 
the organization’s experience, the strategies being used, the curricula being developed, and the 
10
level of community involvement. During the first few site visits, this meant following closely 
with the site visit tool. After realizing that the site visit tool was too repetitive, the site visit team 
undertook a modified approach where they covered the key areas with project management and 
then returned to the site visit tool to ensure that all of the relevant areas had been covered. (The 
tool has been modified to reduce this repetition.) 
The ABY partners were also asked to arrange for meetings between the evaluators and field staff 
during the afternoons. These meetings provided an opportunity to talk to the persons who were 
implementing the program including project trainers, trained teachers, and trained peer 
educators. The objectives of these meetings were to find out from the key implementers whether 
they felt properly equipped to undertake their work. While the evaluators asked the ABY 
partners to involve one or two trainers, two or three peer educators, two or three teachers, and if 
available trained parents/caregivers (one program), the composition of those who were available 
for the meeting varied. In some sites, the evaluators had extensive discussions with a pair of peer 
educators while in other sites, the evaluators undertook an informal focus group with all peer 
educators who had been invited (and waiting since the morning to meet with the evaluators). 
While tools were developed for questioning of these field staff, depending on the 
setting/approach the tool was more or less helpful for leading the discussion (i.e., the tool was 
not developed as a focus group guide). The type of information gleaned in the small group versus 
the larger group approach was different and revealing. For example, when one-on-one interviews 
happened with peer educators or with pairs of peer educators, evaluators obtained greater depth 
on peer educator activities and challenges with their job. When the group was larger, less depth 
was obtained on activities underway but more depth was obtained on gaps in training through the 
group’s questions back to the evaluators on issues related to HIV/AIDS prevention. In the one 
case where the evaluator met with a large group of trained parent/caregivers, it became clear that 
while the parent group was clearly committed to the program, they felt that they could do more if 
they had more resources (for travel) and had materials that were translated in the local language. 
Less depth on specific household activities with their parent/caregiver counterpart groups was 
obtained in this discussion. 
Overall, interviews with trained project staff (e.g., trainers, peer educators, teachers) were 
valuable and these people appreciated the opportunity to provide recommendations for program 
improvement. A number of the specific program recommendations came directly from the voices 
of the field staff. 
2.6 Limitations of Process Evaluation 
This process evaluation, that included all but one of the centrally-funded ABY partners, is not 
without limitations. First, because many of the programs were still in the design phase, 
information obtained on some of the strategies was less comprehensive than desired. In 
particular, the evaluators did not obtain depth of information on mass media, parent/caregiver 
programs, and complementary activities such as referrals and linkages to voluntary counseling 
and testing services. Some reasons for these gaps in information include: a) a lack of structure in 
some of these activities that made it difficult to assess program characteristics (e.g., 
parent/caregiver programs were being undertaken as informal workshops); b) some activities 
were being funded through other sources, limiting the evaluators ability to determine what part 
11
was funded or run by the ABY program; and c) the short duration of the site visits, which limited 
the scope of information obtained. 
The second limitation was that the evaluators did not undertake direct observations of program 
implementation. While direct observation is often useful, it requires more than one site visit and 
multiple observations to ensure a representative perspective of program implementation. This 
was beyond the scope of this evaluation. Third, the evaluators did not meet with the ABY 
beneficiaries. This was also considered outside the scope of this evaluation and details of 
beneficiary exposure and perceptions of the program will come from the outcome evaluation 
with a sub-sample of the ABY partners. Fourth, in cases where ABY partners had in-country 
implementing partners — some as many as 20 — the evaluators were able to meet with only a 
few of the local organizations working with each ABY partner. Fifth, the site visit methodology 
did not permit an assessment of whether programs are being implemented in the recommended 
manner (i.e., every lesson is taught in the assigned order). One way to determine if each lesson 
was being taught would have been to collect and review project monitoring forms (if these 
existed). It was decided that this was outside the scope, especially given the amount of time 
allotted for fieldwork and the desire to provide rapid program strengthening recommendations. 
Finally, in cases where evaluators met with facilitators (teachers, trainers, and peer educators) in 
remote areas of a country, it was necessary to have an interpreter to help obtain standardized 
information. Most times, the interpreters worked for the ABY partner organization, possibly 
limiting the candor of respondents and the depth of information gleaned. 
3. Observations and Recommendations from the Quality Assessment 
This report presents numerous observations and recommendations from the 20 site visits with the 
ABY partners. The observations are meant to demonstrate cross-cutting issues that need to be 
considered at the program design or implementation phases. In the case of observations, there 
was often no “right” approach for all organizations, but the issues raised should be considered by 
project managers. Recommendations are used to reflect issues that affect programming and ways 
to strengthen a specific program type. A comprehensive list of recommendations and 
observations is presented in Appendix A. 
3.1 Summary of Partners Visited and Programmatic Strategies 
As mentioned above, centrally-funded ABY partners were visited in four African countries 
(Kenya, Mozambique, Ethiopia, and Tanzania) and in Haiti for pilot testing (see Table 1). A total 
of 13 centrally-funded ABY partners were visited in these countries. Of the ABY partners 
visited, nine were faith-based organizations and four were secular NGOs. While the overall 
objective of the ABY funding is to work with youth ages 10-24, some of the partners are 
working with specific target audiences, including youth 12-15 years of age; youth aged 10-19; 
unmarried youth aged 10-19; and youth aged 15-24. In addition to their youth target audiences, 
some ABY partners are also targeting adults and/or parents as a means to influencing youth. 
ABY partners are working in multiple settings including schools, churches, and community￾based settings. Various implementation strategies are being employed by ABY partners, with the 
most common being some form of peer education. Other strategies being implemented include 
community mobilization, mass media (mostly radio), and training of adult or parent influencers. 
One program differs from the others in that it uses trained scout leaders to train scouting youth in 
12
a large number of districts and schools. Details of this program are not provided in this report; 
however, issues related to program coordination, program setting, and curricula reflect 
information obtained for this program as well. 
3.2 What Does the ABC Guidance Say about ABY Programming? 
Activities to prevent sexual transmission of HIV under the Emergency Plan are funded under two 
different budget streams — one for abstinence and be faithful (AB), the other for condoms and 
other prevention. All HIV prevention programs funded under the Emergency Plan are required to 
follow specific guidance on abstinence, being faithful, and condom use (ABC) programming. 
This guidance (called the ABC guidance here) was issued by the Office of the U.S. Global AIDS 
Coordinator (OGAC, 2006) and includes recommendations for programming for youth. The two 
key recommendations from the document that are relevant to this report in a number of ways are 
the following: 
• For 10-to-14-year-olds, the Emergency Plan will fund age-appropriate and 
culturally appropriate “AB” programs that include promoting (1) dignity and 
self-worth; (2) the importance of abstinence in reducing the transmission of 
HIV; (3) the importance of delaying sexual debut until marriage; and (4) the 
development of skills for practicing abstinence. 
• For older youth (above age 14) the Emergency Plan will fund ABC programs 
that promote (1) dignity and self worth; (2) the importance of abstinence in 
reducing the transmission of HIV; (3) the importance of delaying sexual 
activity until marriage; (4) the development of skills for practicing abstinence, 
and where appropriate, secondary abstinence; (5) the elimination of casual 
sexual partnerships; (6) the importance of marriage and mutual faithfulness in 
reducing the transmission of HIV among individuals in long-term 
relationships; (7) the importance of HIV counseling and testing; and (8) 
provide full and accurate information about correct and consistent condom use 
as a way to significantly reduce — but not eliminate — the risk of HIV 
infection for those who engage in risky sexual behaviors.
The 14 centrally-funded ABY grantees all receive AB funding counted against the Congressional 
abstinence earmark, which means that the funds are generally restricted to AB activities. An 
observation in the field was that ABY partners were unclear on what was permissible under the 
ABC guidance with AB funding, especially with respect to provision of information and skills 
relating to condoms. For example, a number of programs for the youngest youth focused simply 
on strategies that increased HIV knowledge and changed attitudes, but did little to affect dignity, 
self-worth, or skills, as promoted by the guidance. Similarly, for older youth, programs often 
lacked strategies to identify which youth were the “high-risk” youth, meaning that all youth were 
being targeted with A (and sometimes B) messages predominantly, rather than undertaking a 
more targeted approach as recommended by the guidance. 
Observation: ABY partners need greater technical support from their USAID project 
officers to help them understand what are appropriate strategies and 
messages for each of their target groups and to ensure that the programs 
are implemented in a manner that is technically sound and complies with 
OGAC guidance. 
13
3.3 Program Environment 
Of the 13 ABY partners visited, all but one had undertaken some form of youth programming 
prior to receiving this funding. The prior youth programming experience ranged from running 
religious schools or youth clubs in churches (with or without a health or HIV component) to 
undertaking youth abstinence or reproductive health specific activities. Among the 13 partners 
visited, only about a third had prior USAID funding for youth HIV prevention and/or youth 
reproductive health programming. 
A number of the ABY partners had existing in-country programs or collaborations that were 
expanded or modified with this funding stream. For example, one ABY partner already had 
sponsorship communities where they were working and thus they were able to include 
abstinence and faithfulness activities into the existing programs in these sponsorship 
communities. Other organizations that had existing or prior comprehensive HIV prevention 
programs (supported with or without U.S. government funds) modified their strategies or 
approaches to develop their ABY program. One specific example is the partner that had been 
working for a long time in an urban slum and had a comprehensive youth HIV prevention 
program that included youth recreational centers, youth corners in health centers, and voluntary 
counseling and testing (VCT). For their ABY program, however, this partner divided up the 
urban slum sites to be comprehensive sites or ABY sites; and in the ABY sites, the main 
activities are community mobilization and awareness events, a weaker strategy in this high-risk 
setting. The ABC Guidance suggests that this organization could do more comprehensive 
programs including promotion of VCT and condom use with high-risk sexually active youth in 
the AB target slum sites. This organization, however, was not undertaking these activities 
because its program managers were not sure if this was allowed with AB funding. A 
recommendation to this ABY partner was to undertake skills-development activities (e.g., 
negotiation skills, and relationship skills) for the wider audience, all slum youth, with referral for 
VCT or condom promotion when needed. 
Site visits with partners revealed that many of the project staff were hired after funding was 
received. This means that, for much of the current staff, there was no involvement in project 
conceptualization. When asked about decision-making on program design, curricula, and 
strategies used, some of the ABY partner staff reported that they were given a curriculum and 
design structure and were following what was provided to them. Others were given an initial 
curriculum and design, and spent the first year modifying the activities accordingly. 
A number of project managers mentioned that the pressure of attaining Emergency Plan targets, 
even in the first year when funding was sometimes delayed, affected project planning and 
implementation. In particular, to attain targets, program activities needed to be initiated 
immediately, sometimes before the organization had considered the big picture of who, what, 
where, when, and how. Furthermore, at least two ABY programs reported that pressure to attain 
targets in the first year meant that trainers and peer educators were being trained before the 
development of a curriculum or a training manual. These persons were sent out to lead 
workshops and activities that would count toward the numbers attained, even though it would be 
difficult to pinpoint what messages/strategies were implemented. The organizations that were 
less likely to have these problems either did formative work prior to receiving the funding, had 
prior experience with youth AB programming that could be applied in the nascent stages of the 
14
project, or had a clear conceptual framework that informed the project design and 
implementation. 
Recommendation: Prior to program implementation, develop a logical framework 
that links intervention activities to desired outcomes. 
Only about a quarter of the ABY partners undertook a needs assessment (qualitative and/or 
quantitative) during the first year to help inform project development. These projects had a plan 
to use data (monitoring and/or evaluation) to inform program design and to make program 
modifications throughout the five years of funding. Most of the ABY partners, however, felt that 
this type of assessment or data collection was outside their mandate, given the emphasis on 
reaching large numbers of youth with prevention programming. The advantage of having needs 
assessment data is that programs can be modified to meet the needs of the target audience rather 
than assuming a “one-size-fits-all” approach. While collecting data clearly reduces the amount of 
money available for program activities with youth, it likely strengthens the approaches and 
content of activities undertaken with youth over the life of the project. These types of trade-offs 
between direct reach and strategies for program strengthening need to be considered by each 
ABY partner in collaboration with its USAID project officer to determine the most effective use 
of program funds in each setting where the partner is working. 
Recommendation: Undertake a needs assessment to ensure the program is 
responsive to community needs. 
3.4 Involvement of Church and Community 
A number of the ABY partners are working directly within a church or community-based setting. 
The ABY partners that are FBOs affiliated with a specific church usually had the buy-in of the 
church at the design and development stage of the project. FBOs that are not affiliated with a 
specific church or that try to work outside their own churches and NGOs that try to work in 
churches had a more difficult time getting this buy-in. This was also true for obtaining buy-in 
from community-based partners. A number of the ABY partners that worked with community￾based organizations (CBOs) developed a memorandum of understanding with each of these 
organizations to ensure an organizational commitment to the ABY program. It was not possible 
to tell from site visits with project management, trainers, teachers, and peer educators how 
successful the church and community partnerships were. This would require additional visits 
with these church and community partners, to obtain their input on the process and success. 
Below, under the heading of Program Settings, we discuss some of the programmatic issues that 
come up when working in a church or community-based setting. 
Recommendation: Obtain community buy-in at the outset to encourage greater 
involvement and support at the local level. 
3.5 Program Coordination 
Two main approaches to program coordination were observed: single partner implementation 
and collaboration where the prime ABY partner provides funding with training and direction to 
local implementing organizations. The approach used by the ABY partner sometimes was 
15
consistent across the multiple countries they are working in and sometimes differed across 
countries. For example, two ABY partners were solely implementing their program with a 
standardized strategy across the two countries visited. Conversely, another partner visited in 
multiple countries was solely implementing the program in countries where it had a large prior 
presence; whereas in another country where this organization had a less established presence, the 
partner was serving more in a training and direction role for its local implementing 
organizations. Twelve of the 20 ABY sites visited (see Table 3) were solely implementing their 
programs. 
Table 3. Program Coordination and Setting of Partners Visited by Country 
Haiti Kenya Mozambique Ethiopia Tanzania 
Number of Partners 
Reflected 
3 7 4 2 4 
COORDINATION 
Solely implementing 
program 
3 3 3 1 2 
Collaboration – 
training and 
direction 
0 4 1 1 2 
SETTINGS 
Schools 3 7 3 2 4 
Churches 2 6 4 2 2 
Community 2 6 4 1 3 
Those partners fully implementing project activities are using previously employed field staff 
and new staff hired for this project. In this case, all trainers, supervisors, and peer educators are 
directly affiliated with the ABY-funded organization. An advantage of a partner fully 
coordinating and implementing the program is that the program is more likely to be consistent 
across districts/provinces within the same country where the partner is working. In addition, all 
project staff members have the same program affiliation and are likely to work better as a team 
on program strengthening. Some disadvantages of fully implementing the program by an ABY 
partner include: 
• the project requires a large project staff to attain high coverage; 
• when the project branches out or tries to go to scale, the ABY partner may not 
have natural connections to new communities; and 
• it is more difficult to ensure sustainability of the project if all implementers are 
paid or affiliated with the funded organization. 
Eight of the ABY sites visited are coordinating with other organizations to implement their 
programs either by identifying implementing partners that, in collaboration with the ABY-funded 
partner, undertake the program (five organizations); or by identifying implementing partners that 
with direction and training from the centrally funded ABY partner implement the program (three 
organizations). The stronger programs tended to be those where the funded ABY organization 
was a co-implementer. Conversely, where the ABY funded partner was only providing direction 
16
and training to their implementing partners, the ABY funded organization tended to play a 
funding pass-through role and thus had less of an understanding of how the program was 
implemented. For example, one ABY partner that was in a training and direction role was 
funding a large number of local-level partners (25 in the country visited) to undertake the 
program with no clear guidance on a curriculum or strategy. It was recommended to this partner 
that they should review their partners’ programs and curricula more carefully to ensure that they 
include some minimum criteria including specific messages and skills-based lessons that are part 
of the overall program objectives. 
The main advantage of partnering is that the local partner organizations tend to have good ties to 
the youth in the communities they serve, increasing the visibility and trust of the program. 
Furthermore, for rapid scale-up, using multiple implementing partners can facilitate program 
growth without putting too much burden on one main implementing partner. Finally, for long￾term sustainability, the local partners are the organizations that need to carry the torch for the 
program to continue. The main disadvantage of partnering, as observed in the field, was a lack of 
clarity on the overall program. This is a consequence of using local partners that have worked on 
abstinence issues previously, that either have strategic designs that they have previously used and 
are committed to using or have curricula with which they are comfortable. This means that, in 
some cases where partnering was taking place, there was no underlying project strategy and each 
local partner was implementing the program slightly differently using different curricula, 
supplementing the standardized curriculum, or identifying and working with youth groups 
differently. In a small number of cases, site visits revealed that the main centrally funded ABY 
partner was unaware of the distinctions in program implementation across the local 
implementing partners. Having wide variability in program implementation through multiple 
partners is not necessarily a problem. However, at the end of the five-year funding period when 
the ABY partner is asked what it did, there may not be a clear way to define the underlying 
program, or an obvious way to replicate the program. 
Some successful partnering strategies were observed. The most successful partnership had a 
consistent program strategy across all partners. In particular, each phase of the training of 
trainers (for each partner) is done for all of the partner organizations together. Each partner is 
trained on the specific curriculum or program component and is sent away with common 
materials to use for its subsequent training. This results in a strong, consistent strategy and 
messages that are associated with the ABY-funded program. In addition, because all partners are 
learning and implementing at the same time, problems encountered can be shared across the 
partners to undertake program improvements across all partners, and not just simply at the level 
of one specific partner. 
Observation: There are advantages and disadvantages of solely implementing the 
program and of partnering with other organizations for program 
implementation. 
3.6 Program Settings 
Nineteen of the ABY sites visited undertake activities in schools (see Table 3). Undertaking the 
ABY program in schools has the advantage of including a large and attentive audience of youth. 
Some school-based programs are being undertaken within the classroom setting. The curriculum 
17
is being taught by either a peer educator, project trainer, or by a trained classroom teacher. The 
programs that are the most successful at getting classroom time tended to have approval of the 
country’s ministry of education prior to program implementation. Given that the material in the 
ABY curriculum is not part of the subject matter that students are tested on at the end of the year, 
it is often difficult to get classroom time for program implementation. In some cases, partners are 
using a time set aside each week (about 30 to 45 minutes) for religious studies or time set aside 
for HIV/AIDS education (an hour each week in Kenya) as an opportunity to undertake the ABY 
program. A common complaint of trainers, peer educators, and teachers who are meant to 
implement activities during the school day is that the sessions are not long enough to be able to 
complete a lesson that might take from 45 to 90 minutes. In addition, the most effective curricula 
have multiple sessions that last a minimum of about 14 hours (Kirby, 2001), which would 
require an extensive amount of classroom time over the school year. 
Another school-based strategy commonly used in Kenya and elsewhere is to train youth in 
extracurricular health clubs. Each week in Kenya, time is set aside as part of the school day for 
extracurricular clubs. Youth choose what club to attend and participate in activities with that club 
throughout the school year. A number of ABY programs (and other youth programs) are using 
this extracurricular time as an opportunity to interact with youth in a school-based setting. Often, 
the ABY partner will approach a health club (or an AIDS club) or initiate an ABY club for its 
program activities. In some cases, ABY partners working in school-based clubs will identify two 
youth from the health club (and sometimes an affiliated teacher) to be peer leaders who train the 
other members of their clubs. In other cases, the entire club may be taught the material in the 
program by a trained project staff member or a trained teacher. The advantage of working 
through the club mechanism is that it provides access to youth who participate voluntarily and 
who have regular meetings. The disadvantage is that the participating youth are self-selected to 
participate in the club, and thus may be the youth with the least need of an ABY program. In 
addition, using the club approach, only a small number of youth in the school-based setting are 
actually reached by the program. The effectiveness of the club-based strategy requires that the 
messages and skills are diffused beyond the club and into the wider school community setting. 
At least two of the ABY programs include some form of “multiplier” or “mobilizer” role for 
participating youth in the health club. Over the course of the intervention, one curriculum 
requires participants to undertake outreach through discussions with or presentations to their 
peers outside the club. Having an outreach component increases the likelihood that the program 
is able to have wider impacts beyond the targeted health club. A common recommendation to 
ABY partners implementing programs in a club setting was to include some form of systematic 
outreach beyond the trained members of the club. 
Sixteen of the programs visited are working in church-based settings to identify youth groups or 
to sensitize the church community to the ABY program. Some church-based programs train 
pastors to relay ABY messages during a sermon or in a smaller-group setting. In addition, in 
some cases pastors or Sunday school teachers will teach youth groups or Sunday school classes 
with a specific curriculum. A primary advantage of working with church-based youth groups is 
that the groups have an existing structure and regular meeting times that can be used by a 
program to undertake a formal curriculum, either by trained peer educators or project trainers. 
Some challenges observed with undertaking the program in church-based settings as reported by 
ABY partners are: 
18
• youth groups in churches are sometimes not as large as originally expected, 
meaning that the number of youth reached is smaller than planned; and 
• there is a need to involve church leaders (some programs found that if pastors 
were not supportive of the program, activities for the youth group tended to be 
less successful). 
Programs that were successful in church-based settings often did not only obtain the approval of 
the church leaders but also gave them formal training so that they could be active participants in 
the program and provide accurate information to youth and adult influencers in their 
communities. A small number of the ABY partners have pastors who work as part of their 
project staff. These project pastors are able to lead trainings and interactions with the church 
leaders. 
Activities in community-based settings varied across the programs, but the main objectives of the 
15 programs undertaking community-based activities were to reach out-of-school youth and to 
encourage community dialogue around youth HIV prevention issues. Some community-based 
programs trained youth in local youth associations either to be peer educators or to undertake 
community theater with AB focused messages. In addition, communities are where a number of 
activities for parents and other adult influencers took place either using a formal curriculum or 
engaging a dialogue on a specific topic. One example was a community conversation on child 
abuse that was implemented by one ABY partner in communities where the partner worked. The 
community dialogue on child abuse took place just prior to beginning peer educator training on 
the same topic. 
The advantage of working in community-based settings is that the program can cast a net that is 
wider than just school-based or church-based youth, often targeting the environment that affects 
youth behaviors (Speizer et al., 2003). In addition, community-based programs can target youth 
at high-risk of HIV or youth with HIV. For example, one program was undertaking training 
sessions for persons living with HIV/AIDS and having them undertake activities in their 
communities to reduce stigma and discrimination. ABY partners reported that a disadvantage of 
undertaking programs in community-based settings is that it is often difficult to implement a 
curriculum or a set of consistent skills and messages to the same audience, given the informal 
nature of the setting. This means that the intervention needs to be designed so that each session 
contains key lessons and skills that the participants can practice and apply based on current 
program exposure and that do not require exposure to prior sessions. 
The overwhelming majority of ABY partners are working in multiple settings and implementing 
multi-component programs. For example, project trainers may train youth in schools, may work 
with church-based youth groups, and may undertake community dialogues on stigma and 
discrimination with adult influencers. In another case, project staff train peer educators who 
intervene with youth in both school clubs and church groups. Trained peer educators may 
undertake community-based events such as drama or concerts with messages on abstinence and 
faithfulness. Notably, these multiple-setting, multiple-component programs have both direct 
reach to target youth using a skills-based curriculum and an indirect reach to target youth 
through community mobilization type events. The potential for an impact likely depends on the 
ratio of direct to indirect reach in these settings (see “3.14 Program Research”). 
19
Greater Depth in Curricula 
Peer educators, trainers, and teachers often 
requested greater depth in the curricula, 
including information on sexually transmitted 
infections (signs, symptoms, pictures); drug and 
alcohol use; relationship skills; child abuse; HIV 
testing; and parent-child communication. 
Some ABY partners working in multiple settings recognized the need to tailor their program 
activities and curricula to the different target audiences. For example, one partner that undertakes 
peer education in community-based or church-based settings was asked by the ministry of 
education to implement its curriculum-based program in the public schools (using project 
trainers as facilitators). This faith-based partner needed, however, to adapt the curriculum for the 
school-based implementation. Other partners are using the same materials (curricula or 
scenarios) in each setting, with no modification for the target group or audience. As discussed 
below, stronger programs generally tailored their messages (or curricula) to the appropriate 
target audience rather than using a one-size-fits all approach. 
Observation: Many programs are implemented in multiple settings to affect 
individual youth (e.g., schools and churches) and the environment 
within which they live (community-based activities). 
3.7 Curricula-Based Programs 
Almost all of the funded ABY partners use at 
least one curriculum for their program 
activities.2
 Most of these curricula were 
developed specifically for this funding stream 
using a blend of other curricula, or based on 
focus group discussions on what is needed for 
an ABY program (see Table 4). The new 
curricula being used were developed either by 
the project staff or in collaboration with 
curriculum experts from other organizations. 
Two of the curricula — Choose Life 
(developed by World Relief, Baltimore) and 
Together We Can (developed by the International Federation of Red Cross and Red Crescent 
Societies) — existed prior to this funding mechanism but have been updated or modified for the 
local countries where they are being used. With the exception of the Together We Can 
curriculum that was evaluated in terms of effects on peer educators in Jamaica, none of the 
curricula being used for the ABY programs has been evaluated previously, so the potential for an 
impact of these programs is unknown. 
Some of the ABY partners use the same curriculum for all youth, no matter the age or marital 
status, while others use different curricula for each target group. A recommendation common to 
partners with only one curriculum was that they need to identify or develop curricula and 
teaching tools for their varying target audiences. For example, the curriculum for in-school youth 
10-14 years of age will focus on self-worth and abstinence skills while the curriculum for older, 
out-of-school youth might also include issues of faithfulness, sexually transmitted infections, and 
 
2
 A small number of the ABY partners visited were still developing their curricula and thus were not yet 
curriculum-based. These partners were piecing together sections of other curricula for program activities, resulting 
in weak current program implementation. An extensive review of the ABY curricula being used by centrally 
funeded ABY partners in Kenya, Mozambique, Tanzania, and Ethiopia is being undertaken as a separate report in 
the spring. This will include a review of whether the curricula meet the content characteristics of the 24 standards 
of effective curriculum-based programs as defined by Senderowitz and Kirby (2006). 
20
condom use. Another common recommendation was that the teaching tools and curricula need to 
be developed in local languages, especially for ABY partners working with rural or out-of-school 
youth, and partners working with adults or parent influencers. 
Recommendation: Use different curricula and teaching tools for the varying target 
audiences by age and marital status group.
All of the formal curricula being used include specific lessons to increase knowledge about 
abstinence and encourage positive attitudes towards abstinence. Fewer were skills-based 
curricula that focused on increasing self-efficacy, self-worth, and refusal skills. Notable gaps in 
most of the funded activities are specific messages, skills-based lessons, and strategies on partner 
reduction or mutual fidelity for sexually active youth. This was true for programs that targeted 
the youngest youth (10-14 years of age), programs that targeted youth aged 15-24, and both 
faith-based and non-faith-based partners. The funded ABY partners are well placed to address 
the important gap in skills-based teaching strategies on faithfulness in the existing curricula 
during this five-year funding period. While not based on a formal curriculum, there were, 
however, some organizations presenting partner reduction messages through outreach including 
community theater and mass media. 
Table 4. Characteristics of Programs of Partners Visited by Country 
Haiti Kenya Mozambique Ethiopia Tanzania 
Number of Partners Reflected 2 7 3 2 4 
STRATEGIES 
Peer education 2 6 3 2 4 
Community interaction or mobilization 2 6 3 1 4 
Mass media 2 3 0 (1)‡
 2 
Training parents/caregivers (1)‡
 5 2 2 2 
Adult-led 1 3 2 0 3 
CURRICULUM †
 
Previously existing curriculum 2 1 2 0 1 
Curriculum developed for ABY program 0 6 1 1 3 
Skills-based strategies 2 5 3 1 3 
Specific curriculum for PE to use 2 4 3 1 4 
Number of partners reflected in this table only represent those organizations visited that had active activities in the field at the time of visit. One 
organization in Haiti and one in Mozambique were actively developing their programs but had not completely resolved details of program 
strategy. 
† One partner is funding a number of other partners to implement the program with varying curricula/strategies and thus is not reflected here. 
‡ Figures in parentheses indicate that a partner has this as a planned activity. 
The evaluators’ undertook a subjective characterization of curriculum content by determining the 
coverage and depth allotted by the programs to abstinence, fidelity/monogamy, and condom use. 
While seven of the 12 curricula being used by partners at sites visited by the evaluation team 
include some condom information, only four were comprehensive curricula with specific 
sessions in the curriculum on condom information and negotiating skills. Including condom 
negotiation and skills was not a requirement of the funding stream, but those partners who chose 
to include this material often did so to meet the needs of their target audience. Among the other 
partners, at least five reported that they had a primarily AB curriculum with minimal discussion 
of condoms. In these cases, condoms are often addressed in a frequently asked questions section 
21
or an appendix of the peer education trainers manual, intended to prepare program messengers to 
respond to questions rather than being an explicit part of the program lesson plans. It was found 
that the messengers of these AB focused programs (teachers or peer educators) were not usually 
trained on how to deliver the appendix condom material when needed (see “3.13 Training of 
Trainers and Messengers”). 
Recommendation: Curricula need to include specific messages and strategies for 
sexually active youth. 
The curriculum-based program with the most promise of having an impact on youth beneficiaries 
was a peer education strategy that had a two-stage curriculum. The first curriculum is 
predominantly about HIV/AIDS and its risks. After an initial five-day intensive peer educator 
training on this first curriculum, the peer educators train their groups with the first curriculum 
once a week over a three month period. Then the peer educators return for a follow-up training 
on an advanced curriculum that provides skills-based strategies to remain abstinent or faithful. 
Peer educators return to their same groups and present this second curriculum using the materials 
provided. This two step process recognizes that learning is done in stages and that both the peer 
educators and the youth they work with need a long-term commitment to change behaviors. Few 
other programs have any plans for booster or follow-up activities with youth beneficiaries. 
Some additional recommendations related to curriculum-based programs that came out of the site 
visits with ABY partners include the following: 
• Refresher training — It is crucial to undertake refresher training of the 
messengers (trainers, teachers, peer educators) at least annually or anytime 
that a program makes significant modifications to the curriculum. Refresher 
training should include material on emerging topics that peer educators or 
teachers request more information on. 
Recommendation: Refresher training of messengers is important 
anytime the curriculum changes.
• Undertake booster sessions — With strong ABY partners, it is important to 
determine strategies to undertake follow-up activities (a booster program) 
with youth beneficiaries to strengthen the potential for the program to affect 
behaviors over the long-term, after the initial intervention is completed. The 
booster curriculum can be a modified and shortened version of the original 
curriculum or can provide more advanced behavior change skills. 
Recommendation: Include a booster session to affect behaviors over 
the long-term.
• Modify curricula to local settings and languages — Curricula need to be 
modified to local country settings and translated into local languages. In some 
cases, ABY partners modified activities that worked in certain settings, but 
did not work well in others. Curricula should be modified using curriculum 
22
Peer Educator Certification 
One partner remarked that having a certification 
process strengthens the peer educators’ 
commitment to the program and ensures that, 
once their program involvement is over, they 
can use the training as a stepping stone to 
another activity.
experts who are able to protect the intention and direction of the curriculum 
but tailor the examples and strategies to the local context. 
Recommendation: Curricula need to be modified to local country 
settings and translated into local languages.
• Importance of skills-based curricula — Curricula need to build skills (e.g., 
negotiation and communication skills) and not simply raise knowledge of 
abstinence and HIV/AIDS. While most of the ABY partners used curricula 
with some skills-based lessons, all of the curricula would be strengthened by 
determining the extent that all lessons can include skills-based learning 
strategies. 
Recommendation: Build skills of the target youth rather than simply 
increasing knowledge and improving attitudes.
Many of the programs implemented their curriculum-based programs using peer educators, 
trainers, or trained teachers. Details on issues relevant to training of these project messengers are 
provided under section “3.13 Training of Trainers and Messengers,” and details on issues 
specific to peer education are discussed in the next section, “3.8 Peer Education.” 
3.8 Peer Education 
Using young people to influence their peers 
(peer education) is the most common strategy 
being implemented by the ABY partners. 
Some of these peer education activities take 
place in schools, some in churches, some in 
communities, and some in multiple settings. 
Most peer education programs have a training 
manual to train peer educators. Training 
manuals for peer educators included 
facilitation skills on how to lead a variety of 
activities, including role-playing and how to 
lead group discussions and, in some cases, 
some basic counseling skills. This ensures that peer educators are able to engage their peer 
groups in skills-based learning strategies. In addition, peer educators need to have in hand a 
curriculum to use with their peers. This will increase their confidence and ability to implement 
the program and to relay the messages in a consistent and accurate manner. While most of the 
ABY peer education programs had a curriculum (often in draft format), only a small number 
actually provided hard copies for the peer educators to keep and refer to in their intervention 
activities. 
Key standards for effective curriculum-based programs relevant to peer education include that 
peer educators need to be trained by staff trainers or professional trainers (FHI/YouthNet and Y￾PEER, 2005). Upon completion of the training, peer educators need to be supported by their 
23
trainers/supervisors and receive coaching or mentorship as they interact with their contacts in a 
group or one-on-one session. Furthermore, peer educators need supervision to ensure that they 
understand the importance of presenting the material in the manner provided and to encourage 
them to get input from their trainer/supervisor if any problems should arise (FHI/YouthNet and 
Y-PEER, 2005). To ensure that peer educators receive the attention they need, there needs to be 
a reasonable ratio between trainers/mentors and peer educators. One ABY partner had a ratio of 
about one trainer/mentor to 60 peer educators, which seemed reasonable. Conversely, another 
ABY partner expects each trainer/mentor to work with over 200 peer educators. Therefore, 
while nearly all of the ABY programs intended for the peer educators to be supervised and 
mentored, not all had feasible strategies for carrying out the supervision and mentoring, given 
problems with the structure or design of the program. 
Only one of the ABY partners visited specifically asked peer educators to undertake one-on-one 
discussions with their beneficiary youth, whereas most others used group settings for the peer 
educators to interact with their peers. Some of these group settings were existing groups such as 
school-based health clubs or church groups, while others were groups formed specifically for the 
ABY program. An observation from the field was that peer educators seemed more successful at 
intervening with a group when they had a natural affiliation to the group and the group existed 
before the ABY program began. In cases where groups were created for an ABY program, the 
meetings were less regularly attended and the peer educators selected were not necessarily the 
natural leaders of the groups. 
Other important approaches identified for strengthening peer education strategies include the 
following: 
Selection criteria — While almost all of the ABY programs indicated that they had 
selection criteria for peer educators, not all applied the selection criteria in practice. Some 
of the criteria for selection included that the peer educator needed to be a role model to 
the target youth, have good communication skills, be within certain age groups, have 
previous experience working with youth or participating in HIV prevention activities, and 
receive recommendations from school officials or community leaders. In addition, some 
of the ABY partners required the peer educators to take an abstinence or faithfulness 
pledge, depending on their age and marital status. 
Recommendation: Select peer educators based on pre-determined 
selection criteria. 
Incentives to participate as peer educators — Incentives can be as small as t-shirts and 
caps, which at the minimum help the peer educators be recognized as affiliated with the 
partner organization. Peer educators from two programs visited felt that they would be 
able to recruit and attract more youth if they had soccer balls and could undertake pick-up 
games of soccer. These soccer balls could have project logos that increase recognition of 
the project and increase involvement of new groups of youth. 
Recommendation: Consider giving incentives to peer educators. 
24
Travel expenses/reimbursement of transportation costs — Peer educators mentioned 
that having reimbursement for travel expenses to participate in community mobilization 
activities would increase their potential reach. 
Recommendation: Provide travel expenses to peer educators. 
Encouraging out-of-school youth as peer educators — Some out-of-school youth 
reported that their families discouraged them from participating in volunteer outreach 
activities, rather than using the time to work in the home and being an asset to the 
household. Therefore, it may be necessary to pay a small stipend or identify incentives 
that are meaningful to the family for these out-of-school peer educators to help validate 
their work. 
Recommendation: Out-of-school peer educators may need incentives 
to validate their work.
Brochures — Providing brochures for peer educators to distribute to the youth they 
interact with not only ensures that peer educators can refer back to the brochures to 
remind themselves of important facts and increase their confidence, but also allows their 
beneficiaries to take concrete information home with them to share, rather than rely upon 
memory of what they heard from the peer educator. Some of the ABY partners that used 
brochures were able to obtain these from their national AIDS control program or from 
other NGOs working on HIV prevention among youth. 
Recommendation: Provide brochures to peer educators to distribute.
Competency testing —Several of the ABY partners have pre/post tests of peer educator 
training, to ensure that peer educators understand the material and are able to present it 
back to a group. Few, however, had a structured way for trainers to identify and correct 
specific weaknesses among individual peer educators or among the group of peer 
educators trained. 
Recommendation: Have a mechanism to ensure peer educators are 
competent and able to present the material.
Counseling skills — Depending on the target group for peer educators and trainers, the 
program may need to provide training on counseling skills. While adult counselors may 
be available to participating youth, it was clear that most peer educators requested 
counseling skills because they felt that their youth beneficiaries trusted them and these 
beneficiaries would be less comfortable approaching unfamiliar adult counselors. That 
said, training on counseling skills is expensive. An alternative approach is to include 
trained counselors as part of the project team, allowing peer educators to refer their 
beneficiaries to these counselors rather than to counselors outside the project structure. 
Recommendation: Consider providing counseling skills or 
incorporating other trained counselors into the 
program. 
25
Long-term job prospects — A number of ABY project staff members were themselves 
peer educators for previous programs. Programs should consider strategies to retain 
trained peer educators through a formal commitment to the program, the possibility for 
moving up in the program after a certain amount of time working with the program, and 
by offering other training options to increase competency of peer educators. In addition, 
working closely with peer educators to determine an appropriate scope of work would 
reduce their discouragement of being asked to do too much without the necessary 
support. 
Recommendation: Consider strategies to retain peer educators by 
providing them opportunities for professional 
development.
Cascade training — Using a cascade approach (training peer educators who then train 
the next cadre of peer educators) can lead to a large number of “trained” individuals. The 
disadvantage, however, is that the second- and third-tier peer educators often lack 
support, mentoring, and supervision — key components of effective programming. 
Moreover, the quality of the training by peer educators likely deteriorates with each new 
tier, as the cascade approach becomes further removed from the original training 
conducted by professional trainers. A cascade strategy of training adult facilitators was 
also being applied by one of the ABY partners. ABY partners that were undertaking or 
planning to undertake a cascade approach (of peer educators or adults) were given a 
recommendation to rethink this strategy to avoid the program becoming weaker over 
time. 
Recommendation: Avoid a cascade approach to training peer 
educators as this can lead to a lower quality 
program over time. 
Using older peer educators — Peer educators who are 10-14 years of age are likely to 
be too young to be leading the program themselves. Meetings with these younger peer 
educators revealed a lack of confidence in relaying project messages, inexperience in 
speaking and working with a group of peers, and reported problems of the educator not 
being taken seriously by other youth of the same age or older. Partnering these younger 
peer educators with older peer educators or trained teachers may help to ensure that 
messages are relayed appropriately and consistently in the program. 
Recommendation: Partner young peer educators with older peer 
educators whenever possible. 
Peer educators also need to be trained at a level higher than the age group of the youth they will 
work with, so that they are better able to address difficult questions posed to them and so they 
are seen as reliable sources of information by their peers. When peer educators were asked how 
they would respond to questions on condom use or sexuality, they gave varying responses that 
often reflected their personal opinions rather than program-supported messages. 
26
Peer educators, while important role models, also need to have the tools (a curriculum or 
scenarios to work from) to train their peers (in groups or one-on-one) on skills-building activities 
that encourage abstinence and fidelity. In a number of cases, peer educators reported that they 
knew what to do, but did not have materials to work from to help standardize their approaches. 
3.9 Adult-Led Programs 
Nine of the ABY sites visited were using trained adults as the program messengers in a school, 
church, or community-based setting (see Table 4). Often, these adult messengers were teachers 
in a school or people who typically work with youth in a church or CBO. Some unique adult-led 
approaches observed included training scout and girl-guide leaders in schools to work with their 
groups, training Sunday-school teachers, and using trained adults to work with community 
groups of parents and adult influencers. The more successful programs that used adult facilitators 
trained the facilitators using a structured training and provided a curriculum for them to use with 
their target audience. Other program specific issues related to adult-led approaches are discussed 
under “3.7 Curriculum-Based Programs” and “3.13 Training of Trainers and Messengers.”
The advantage of using adults to lead the program is that they are considered to be reliable 
sources of information and may be better able to understand and present the material back to a 
group of youth or a group of parents or other adults (Durantini, Albarracin, Mitchell et al, 2006). 
The disadvantages of involving adults include the fact that teachers have limited time for training 
and for extra activities beyond their school curriculum; that adults may give biased information 
based on their own personal perspectives of whether youth should or should not be sexually 
active; that over the adolescent years, youth tend to be influenced more by their peers than 
adults, so adults may not be the appropriate messengers for older youth; and that because many 
adults are busy already, it is difficult to get their commitment for this type of volunteer work 
(including the time for the training) (Svenson and Burke, 2005; Durantini et al., 2006). 
To date, there is no clear determination on whether youth HIV prevention programs from sub￾Saharan Africa (and the Caribbean) are more or less effective when adults are the facilitators 
rather than using youth facilitators (Durantini et al., 2006). In a recent assessment of evidence￾based programs undertaken by the UNAIDS Inter-agency Task Team on Young People, 
curriculum-based programs led by adults or teachers were found to be effective (Ross et al., 
2006). This report, however, only found a small number of curriculum-based programs led by 
peers and had no studies that compared adults to peer facilitators. One study in the United States 
indicated that, among African American youth in an inner-city setting, there were no differences 
by whether the facilitator was an adult or peer (Jemmott, Jemmott, Fong, 1998). 
Recommendation: Programs that use adult facilitators need to ensure that these 
facilitators receive a structured training and are provided with a 
curriculum to use with their target audience. 
3.10 Community Interaction 
This section describes some of the community mobilization and interaction activities. The 
distinction being made between mobilization and interaction is that generally community 
mobilization comes from internal forces of the community whereas most of the activities 
27
Using Youth-Developed Drama 
An ABY partner is co-sponsoring a national drama 
festival in which AB is among the themes. The 
partner plans to select the best performances at the 
national, regional, and district levels and videotape 
the winners. These videotaped presentations will 
then be used by the partner to provide messages 
using the youths’ own voices. 
described by the ABY partners were interactions with the community by peer educators, trainers, 
or youth groups. These interactions were rarely initiated through community forces. The 
community interaction activities included theater (using ABY program trained theater groups), 
sporting events, debates, music competitions, and school-based assemblies. Community 
interactions and mobilization are important strategies for changing community norms around 
abstinence and fidelity. In addition, they can be used to reduce stigma and discrimination. 
Notably, community interactions and mobilization on their own are not enough to build skills of 
the target audience, which includes all youth. 
Stronger community interaction programs 
used trained peer educators and their 
participating youth groups to undertake 
drama, debates, and other events. Better 
programs also undertook community 
interactions at numerous levels to ensure 
that the ABY messages were being relayed 
consistently and constantly over the project 
period. Finally, community interactions 
often provided a forum for discussion of 
some of the difficult topics including 
gender-based violence, cross-generational 
sex, and sex in exchange for money. 
Through drama and debates on these issues, youth and adult influencers are being encouraged to 
consider these problems and discuss potential responses together. 
During the site visits, the evaluation team met with a number of extremely motivated trained 
drama groups. In most cases these drama groups were trained in theatrical techniques but were 
not given the HIV/AIDS prevention program training that the peer educators were given; this 
was considered to be a gap in their training. In addition, these groups felt that if they received 
travel fees and possibly some additional stipend, they would be able to perform more often and 
more widely, increasing the visibility of their messages. Many of the concerns of the drama 
group members were similar to those of peer educators, including the desire for certification, the 
need for some incentives, and concerns about how much volunteer time they could give. 
It should be noted that some of the drama groups that were trained to undertake programs with 
an abstinence and faithfulness theme felt that they were putting themselves in vulnerable 
situations by discussing difficult topics in such a public manner. In particular, one group of 
theater youth said they faced a lot of resistance at first from the communities they were working 
in (not necessarily their own communities) and even after they were accepted and valued, they 
were still called the “AIDS guys,” which made them feel uncomfortable. In these cases, it is 
clear that drama members (or others presenting difficult topics in community-wide settings) need 
support at the time of entering a community and help to maintain their enthusiasm for the work 
they do. 
Recommendations: Use trained peer educators and their beneficiary groups for 
community interactions; undertake community interactions at 
numerous levels, and consider strategies to support youth who 
undertake community interactions. 
28
3.11 Mass Media 
Eight of the ABY sites visited either have or are planning on undertaking mass media activities. 
The delay in implementing the media program relates to a reduced emphasis on media programs 
in the Emergency Plan program guidance. During the site visits, the amount of information 
obtained on mass media activities was not sufficient to make strong recommendations on 
program strengthening in this area. This was because many of the activities were still under 
development and the evaluation team was unable to review and assess the quality of the current 
activities. 
A number of partners indicated that while they intended to include a media component, it was an 
expensive endeavor, especially if they planned on using television. Those with the most 
established media programs tended to have had media activities prior to this funding stream. One 
partner was using the television two times a week for 30-minute sessions covering topics from 
the partner’s manual. This partner reported that television exposure was monitored each quarter 
to assess reach and reception of messages. Based on monitoring of radio messages, this same 
partner decided to discontinue its radio programs and recommence them after revising the 
content and determining the most appropriate radio stations. 
ABY radio programming typically includes call-in shows with question and answer sessions, 
testimonials from abstinent youth, and short dramas. Some partners were using local radio 
stations and Christian radio stations to promote ABY messages with programming input from 
youth. One of these partners also encourages radio listening clubs as a way of fostering dedicated 
listeners from the target audience. These listening clubs are often made up of youth from the 
same AIDS and abstinence clubs the partner is already working with in and out of school. While 
youth may benefit from receiving ABY messages from multiple sources, the use of listening 
clubs as a means of disseminating messages to a wider audience has limited potential reach. 
Another partner was in the process of training managers of government educational radio 
stations on ABY radio programming at the time of the site visits with the intention of reaching 
more rural populations with ABY messages. The success of this training of managers will need 
to be assessed in later site visits. 
3.12 Parent and Caregiver Programs 
The site visits took place with centrally-funded ABY partners at a time when some of the 
partners had only been funded for one year to 18 months (others as long as 30 months). This 
means that some were in the initial phase of project development and implementation. That said, 
while a number of projects had planned to undertake parent-child communication activities, only 
a few had reached out to parents and only two had a formal curriculum for working with parent 
and adult influencers as of the time of the site visits. One of these organizations that had a 
curriculum had active parent/caregiver groups that were part of the program. There was a request 
by members of the parenting/caregiver group that the curriculum be translated into the local 
language so that they could train others with the material. This parenting/caregiver group also 
felt that they could do more outreach and support activities for persons living with HIV/AIDS if 
they were given additional training and some travel fees. 
29
The other organizations that had undertaken activities with parents or caregivers were 
undertaking mini-sessions or workshops with these influencers to help them understand their role 
in HIV prevention. This included one organization that used four lessons (no formal curriculum) 
for groups of 50 parents undertaken in each district where this organization was working. The 
parenting groups were found to be so popular that this organization was repeating them 
throughout the sites. Whether and how well these parent/caregiver programs are implemented 
will need to be assessed at future site visits. 
An observation from trainers and facilitators who work with parent or adult groups was that 
specific training materials or curricula are needed to work with adult groups. In addition, the 
facilitators of the groups felt that they needed to be trained on adult facilitation skills because the 
skills they learned for working with youth were often not appropriate. In one example, the 
trainers were supposed to undertake a training session with adults using the youth curriculum 
that starts with listing all the words for “sex.” These trainers said that this did not feel like an 
appropriate ice-breaker activity for working with an adult group, especially since the trainers 
were intentionally selected to be closer to the youth age group and thus it would be disrespectful 
for them to lead this ice-breaker with their elders. 
Recommendations: Programs that work with parents or caregivers need to have a 
specific skills-based curriculum or organized set of activities for 
this group. All activities and curricula need to be translated into 
the local languages. 
3.13 Training of Trainers and Messengers 
All of the ABY programs use some form of messenger, including trained project staff, trained 
teachers, and trained peer educators. The strongest programs train all project staff, including 
project management and official project trainers. Training of project staff, trainers, and project 
messengers (e.g., peer educators or teachers) requires that the program have facilitation manuals 
that can be used for these trainings. Some of the ABY partners use the same curriculum for all 
levels of training. Others have specific manuals for training of trainers, training of peer 
educators, and for peer educators to use to train their groups (the curriculum). 
Training of project messengers often lasts three to five days, although some partners undertook 
training of up to two weeks. In some cases, ABY partners were shortening the recommended 
training period and undertaking an “orientation” with the peer educators or teachers. The rational 
given for shortening the training was that the messengers already knew about HIV/AIDS and did 
not need detailed information on these topics. This is problematic because, when it comes time 
for program implementation, the program risks disseminating incorrect, out-of-date, or 
inappropriate information. 
In the ideal case, training of trainers, peer educators, or teachers follows a training manual. The 
training and the training manual need to emphasize facilitation skills so project messengers learn 
a variety of strategies to relay messages and skills. It is crucial that time at the training is 
allocated to practicing the skills learned and leading lessons for groups to ensure that the trained 
messengers are able to implement the program appropriately. Training manuals also need to 
include certain core elements related to the program curriculum including: 
30
• an introduction to the material for the messenger; 
• a list of objectives and materials needed for each module; 
• an outline of the module with an expected time frame; and 
• specific skills-building activities related to each module. 
Recommendation: Training should include time allocated to practice skills learned to 
ensure that messengers are able to implement the program 
appropriately. Using training manuals with core elements ensures 
standardized training methods.
Finally, the training of messengers must emphasize the importance of implementing the program 
(i.e., the curriculum) appropriately, including in the order provided, in its entirety, not dropping 
subjects that the messenger does not like, and using the teaching tools recommended – usually 
interactive. When asked, peer educators from one organization reported that they covered the 
material in whatever order they choose. This may be problematic if they are unable to complete 
the curriculum and if the curriculum is designed such that the lessons build on one another (a 
characteristic of a stronger curriculum). Peer educators need to be trained on how to deliver the 
program appropriately. 
Recommendation: The training of facilitators must emphasize the importance of 
implementing the curriculum in its entirety and in the order 
provided. 
There is often a gap in condom training for project messengers, according to those interviewed in 
the field. This was particularly true for training of teachers and peer educators who were meant 
to work with the youngest youth (ages 10-14 and 15-19) or who were working with youth in 
school-based settings. The training manuals and curricula used for these age groups rarely 
included condom information or left this topic to be covered in a “frequently asked questions” 
section. This means that peer educators and teachers do not receive formal training on how to 
respond to the inquisitive youth, nor do they learn how to refer youth to sources of better 
information. When asked difficult questions, the teachers and peer educators reported that they 
refused to answer (stating that this is an abstinence program and condoms or sexuality were not 
part of their program), gave a personal opinion, gave inaccurate information, or were simply 
stymied by the question. The results are that the program messengers (i.e., teachers and peer 
educators) risk appearing to be an unreliable source of information for the participating youth. 
Recommendation: Peer educators and adult facilitators need to be trained to respond 
to questions about condoms and other challenging topics such as 
sexuality.
USAID project officers should work closely with their ABY partners to clarify when it is 
appropriate to include condoms and sexuality issues in the training of peer educators and 
teachers. Partners should ensure that the training includes role playing and skills building so that 
messengers are confident with their responses if asked about condoms, sexuality, or another 
difficult topic. This will ensure that the responses given by messengers are accurate, age￾appropriate, and approved by the ABY partner. 
31
3.14 Program Reach 
An important priority of all of the ABY programs is attaining their target number of youth 
reached during the project period. As previously mentioned, there are cases where project leaders 
intervene with target youth before full project development, resulting in spotty and inconsistent 
strategies. In addition, because there is no clear definition of what it means to be “reached” by 
the ABY programs, some partners are defining this very broadly while others have much more 
rigorous definitions. For example, some partners count a youth as “reached” if she or he attends 
one session of a curriculum-based peer education activity (e.g., in school), attends a community 
interaction event (based on counting the crowd), or is talked to by a peer educator or a multiplier 
through outreach. Other partners defined “reached” by counting only those youth who attend the 
full training (i.e., they participate in all lessons of the curriculum), participate in an event that 
lasts at least three hours and a trainer was present, or interact with a peer educator through one￾on-one interactions for a minimum of five hours. Furthermore, some programs distinguish 
between youth who are reached directly by trained project staff or trained peer educators and 
youth who are reached indirectly in community interactions or by multipliers. Conversely, other 
programs group all of these youth together. Many of the ABY partners that count both direct and 
indirect reach together (or even separately) risk double counting many youth in some 
communities. Double counting of the same participants by multiple ABY partners (centrally 
funded and bilaterally funded) is also a problem, especially in locations where there are multiple 
organizations working with youth. 
An observation in the field was that given the emphasis on reporting large numbers, some 
programs were sacrificing quality of interactions including training, mentoring, and supervision 
of peer educators and focusing on knowledge gain rather than skills building. This means that at 
the end of the funding period, while a program may “reach” large numbers of youth, those youth 
reached may be reached with such weak strategies that the program has no impact. Similarly, a 
project may train a large number of peer educators but the number is too big to ensure that those 
peer educators are appropriately supported and mentored, resulting in a weak implementation of 
the program by “trained” peer educators. Conversely, there are some programs as well that are 
undertaking extremely intense messages/activities with a small number of youth. At the end of 
the project period, these programs are also unlikely to have an impact on the entire community of 
youth at risk. There are clearly trade-offs to be made and no program is assessing the cost 
effectiveness of the activities being undertaken. The cost-effective programs are likely the ones 
that can directly reach a greater number of youth with intense and good quality messages and 
skills over a long time period. These are the programs worth evaluating for long-term impacts. 
Observation: Both direct and indirect reach are important, the first to increase 
skills of participants and the second to change the environment 
within which youth live.
3.15 Observations from Visits with the Same ABY Partner in Multiple Countries 
Five of the ABY partners were visited in at least two countries, and two of these partners were 
visited in three countries. These multi-country site visits provided a perspective of how 
consistent some strategies were cross-nationally and when and why differences were observed. 
In particular, organizations that had consistent strategies across multiple countries tended to have 
32
strong management that originated in the U.S. office and/or strong and consistent management 
across country sites within the program. When the program was more decentralized across sites, 
there was much more variability in the program activities. In some cases, the same organization 
was doing well in one or two sites, but not as well in another site. Moreover, when a program 
had an explicit programming strategy (either by having an existing program description and/or a 
curriculum with details on training, selection criteria, and activities), this often led to stronger 
program activities across countries. Conversely, when the organization was developing curricula 
and coordinating strategies by country, if one country was doing well, it did not necessarily mean 
that the other country was also doing well. 
It should be noted, however, that even in the case where an organization has a structured 
curriculum that is supposed to be used across the multiple countries, this alone did not lead to a 
standardized approach. Having an evidence-based curriculum is a first step to standardization. 
Ensuring standardization requires many additional steps, including: 
• strong management to implement the program; 
• a clear training structure to ensure that trainers and facilitators know how to 
use the curriculum, even if trainers and facilitators come from other local 
implementing partners; and 
• community support for the program whether in a school-based, a church￾based, or a community-based setting. 
3.16 Gaps Identified in Existing ABY Programs 
As previously mentioned, there was a gap in skills-based activities with a focus on faithfulness in 
marriage, partner reduction, and mutual monogamy. Some partners reported that they felt it was 
inconsistent to be promoting abstinence until marriage and also discussing the need to be faithful 
(the unspoken assumption was that if you are abstinent until marriage, you will be faithful in 
marriage). The ABY partners need to develop and implement faithfulness activities that are 
skills-based and target youth who are transitioning to sexual activity or marriage. In addition, 
few programs had specific activities and strategies for sexually-active youth, beyond 
recommending a return to abstinence. A recommendation for programs working with the oldest 
age groups (20-24) was that the programs need to consider programmatic strategies for this 
group, including discussion of condom use, sexually transmitted infections, and referral for 
voluntary counseling and testing, especially since most of these youth are sexually active, often 
outside of marriage. 
An additional gap identified was a lack of clarity on whether programs should be working 
separately with girls and with boys, and if this varied by the target age group. At this point, most 
of the peer education programs include both girls and boys if the school or project site is co-ed 
and are single sex if the site is single sex (e.g., a girls’ boarding school). Few have explicitly 
defined at what point in the intervention girls and boys need to be split up (or not). 
Furthermore, while some of the curricula being used include mention of cross-generational and 
transactional sex, few have developed specific modules and skills-based lessons to address these 
issues. As the HIV prevention field and USAID evolve to understand better the factors 
33
associated with early sexual debut and HIV risk-taking, the ABY partners will be well placed to 
develop strategies to address these key gender issues. One of the ABY partners has recently 
developed four lessons on these topics. At the time of the site visits, these lessons were not yet 
being implemented. A review of the lessons suggests that the content will supplement nicely the 
prior abstinence specific program implemented by this partner by addressing issues related to 
high-risk sexual behaviors and alternatives for sexually experienced and sexually active youth. 
These new lessons also include scenarios that address issues related to cross-generational and 
transactional sex. These four lessons may be worth sharing with the other ABY partners, who are 
also struggling with how to cover these difficult topics. The key characteristics of effective 
programs indicate that approaches are needed that focus on specific behaviors that protect youth 
from risk-taking rather than generic approaches such as “family life education” or “life-skills” 
education (Kirby, 2001; Speizer et al., 2003). Incorporating focused lessons on important gender￾based issues, including cross-generational and transactional sex, is likely to be more effective 
than only promoting abstinence and ignoring issues of power imbalance that put youth at risk of 
coercive and unwanted sex. 
4. Conclusions 
Site visits with the centrally-funded ABY partners that applied a standardized approach to 
obtaining information on program strategies were extremely productive for identifying ways to 
strengthen each of the partner’s activities. The standardized tool that was developed through 
extensive review of published and unpublished literature, development of a framework to 
characterize ABY program activities, and from an expert consultation meeting will be useful for 
the adolescent reproductive health field. The tool has been simplified and developed as a 
resource that can be used at the design and development phase, for new ABY or other adolescent 
reproductive health partners, as well as by funding sources, to assess whether programs have the 
features of higher quality programs. The tool and a description of how to use the tool are 
attached as an appendix to this report (see Appendix E). 
Feedback from the partners and from their USAID points of contact indicates that many of the 
ABY partners modified their work plans based on recommendations from the site visits. The 
information from the site visits was also helpful in providing a perspective on ways these types 
of ABY programs should or should not be implemented in the future. It is interesting to note that 
many of the recommendations that came from the individual site visits and overall review of site 
visits reported here are similar to the list of 24 standards for effective curricula-based programs 
developed by Senderowitz and Kirby (2006) (listed in Table 2). This might be because most of 
the ABY partners use curricula in some form or another. Additionally, these standards were 
included among other criteria in the assessment tool to determine the strength and rigor of the 
programs visited. 
A number of the recommendations from this report are important for ABY programming, 
whether or not a curriculum is used. Some specific examples include the following: 
• A program will be much more holistic and strategic if it is based on some type 
of logical framework (or logic model) that links intervention inputs to 
34
activities to outputs and desired outcomes (this logic model should be 
developed prior to beginning program implementation). 
• Undertaking a needs assessment ensures that a program is responsive to 
community needs. 
• Obtaining community buy-in at the outset will lead to greater involvement and 
support at the local level. 
Programs should consider these three issues at the design phase of the project. However, 
programs that are already underway can also gain enormously from creating a logic model and 
undertaking a needs assessment during program implementation. Creating a logic model 
provides the program an opportunity to determine whether the program strategies and approaches 
are designed to have an impact on desired outcomes. Some organizations may realize that they 
need to redirect resources and activities if there is not an expected direct link between the current 
design and outcomes. Similarly, undertaking a needs assessment can provide the program with 
information on whether the strategies underway are meeting the needs of the community that is 
being served and gives the program an opportunity to adapt the strategies to better meet 
community needs. 
These are just a few examples of the cross-cutting issues that all ABY programs need to consider 
at the design and development phase. In addition, whether a program is a peer education program 
or a program that is led by trained teachers, all project messengers need to be well selected, well 
trained, and well supervised/mentored/coached. Furthermore, curriculum-based and non￾curriculum-based programs need to go beyond increasing knowledge and changing attitudes and 
undertake activities that build skills of the target audience whether youth, parents or caregivers, 
or community leaders. A comprehensive list of recommendations and observations that came out 
of this report is provided in Appendix A. 
It is worth noting that while this report focuses specifically on site visits with abstinence and 
faithfulness programs centrally funded by the Emergency Plan, the findings, recommendations, 
and conclusions are applicable more widely to other centrally and bilaterally funded HIV 
prevention and reproductive health programs for youth. Given the increased funding to 
abstinence programs, there is a need for process evaluations to ensure program quality. The 
findings from this report are useful for funders, policy-makers, and program planners as they 
continue to support, design, and develop abstinence, partner reduction, and reproductive health 
programs for youth. The underlying objective is to undertake programs that are implemented 
rigorously and have the potential to reduce HIV incidence among youth. The only way to 
determine if the programs have an impact, however, is to undertake rigorous outcome 
evaluations, in addition to the process evaluations. 
5. Next Steps 
There are two main next steps that are related to this process evaluation. First, the assessment 
tool that was designed by MEASURE Evaluation for the Phase I process evaluation of ABY 
program quality and rigor will be disseminated to ABY partners and to others who are 
implementing youth reproductive health and HIV prevention programs. The assessment tool 
(attached in Appendix E) could be used by program planners, local evaluators, and funders for 
35
program design, program review, or program strengthening. It can also be used as a monitoring 
tool to determine whether programs make recommended changes over time. 
Second, as mentioned above, the process evaluation site visits were Phase I of a two phase 
targeted evaluation. The objective of Phase II of the targeted evaluation, the outcome evaluation, 
is to better understand if three ABY programs implemented in Mozambique are having 
community-wide impacts in the places where they are working. In particular, MEASURE 
Evaluation has designed a quasi-experimental evaluation study in Inhambane province, 
Mozambique where three of the ABY partners are working. Districts where the partners are 
working will serve as intervention districts and districts where no partners are working will serve 
as comparison districts. The evaluation will involve a population-based household survey of 
7,500 youth ages 10-24 (6,000 ages 10-19 and 1,500 ages 20-24). The survey will obtain 
information on HIV knowledge, attitudes, intentions, and practices. Program exposure will also 
be measured. The study will include dried blood spot HSV-2 (genital herpes) testing as a 
measure of reliability of self-reported sexual behaviors. Baseline data will be collected in 
June/July of 2007 and follow-up data will be collected two years later. Over the follow-up 
period, regular site visits with the ABY partners in Mozambique will be undertaken to ensure 
that they continue to undertake programs of high quality. These visits will provide a 
determination of whether there have been changes in the program strategies that strengthen or 
weaken the project reach and potential impact. These site visits will be crucial for ensuring a 
clear understanding of program implementation characteristics that could be replicated, if the 
programs are found to have an impact on youth HIV risk-taking. 
36
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39
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40
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41
Appendix A. List of Recommendations 
Table A.1 Comprehensive List of Recommendations from ABY Site Visits 
Cross-Cutting Recommendations 
1) Prior to program implementation, develop a logical framework (logic model) that links intervention activities to desired 
outcomes. 
2) Undertake a needs assessment to ensure the program is responsive to community needs. 
3) Obtain community buy-in at the outset to encourage greater involvement and support at the local level. 
Curriculum-Based Program Recommendations 
1) Build skills of the target youth rather than simply increasing knowledge and improving attitudes. 
2) Partners with only one curriculum need to identify or develop curricula and teaching tools for their varying target audiences 
and age groups. 
3) Trainers, teachers, and peer educators should be given refresher training at least annually or anytime that a program makes 
significant modifications to the curriculum. 
4) When possible, programs should consider undertaking follow-up activities (a booster program) with the youth beneficiaries to
strengthen the potential for the program to affect behaviors over the long-term. 
5) Curricula need to be modified to local country settings and translated into local languages 
6) Curricula often lacked specific messages, skills-based lessons, and strategies on partner reduction or mutual fidelity for 
sexually active youth. 
7) Organizations without an identifiable curriculum or set of interventions should develop a standardized programmatic framework 
that directs the overall program. 
Peer Education Program Recommendations 
1) Select peer educators based on pre-determined selection criteria such as: peer educator is a role model to the target youth,
has good communication skills, be within certain age groups, have previous experience working with youth or participating in 
HIV prevention activities, and receive recommendations from school officials or community leaders. 
2) Consider giving incentives to peer educators — this can be as small as t-shirts and caps, which at the minimum help the peer
educators be recognized and affiliated with the partner organization. 
3) Provide travel expenses to peer educators when necessary 
4) Encourage out-of-school youth as peer educators, but consider including additional incentives to help validate their work. 
5) Provide brochures for peer educators to distribute to participants, and for their own reference 
6) In addition to conducting a competency test before and after peer education training, have a mechanism in place for boosting
the knowledge and skills of trainees who do poorly on the posttest. 
7) Consider providing counseling skills to peer educators or incorporating other trained counselors into the program. 
8) Consider strategies to retain trained peer educators by providing them opportunities for professional development and 
advancement. 
9) Partner young peer educators (ages 10 to 14) with older peer educators or only use older peer educators to ensure that 
messages are relayed appropriately and consistently in the program. 
10) Avoid a cascade approach to training peer educators as this can lead to a lower quality program over time. 
Training Recommendations 
1) Peer educators and adult facilitators need to be trained to respond to questions about condoms and other challenging topics 
such as sexuality. This ensures that the project messengers give accurate and consistent responses rather than personal 
opinions that may not be accurate or appropriate. 
2) Training should include time allocated to practicing the skills learned and leading lessons for groups to ensure that the trained 
messengers are able to implement the program appropriately. 
3) Training manuals need to include certain core elements related to the program curriculum including: a) an introduction to the 
material for the messenger; b) a list of objectives and materials needed for each module; c) an outline of the module with an 
expected time frame; and d) specific skills-building activities related to each module. 
4) The training of educators must emphasize the importance of implementing the curriculum in its entirety and in the order 
provided. 
Other Recommendations 
1) Adult-Led Programs (teachers, scout leaders, trainers) 
i. Programs that use adult facilitators need to ensure that these facilitators receive a structured training and are provided 
with a curriculum to use with their target audience. 
2) Community Interaction Programs - community activities were generally initiated by the ABY partners (community interactions) 
rather than initiated from internal community forces (community mobilization). 
i. Use trained peer educators and their youth beneficiary groups to undertake community interactions including drama, 
debates, and other events. 
ii. Undertake community interactions at numerous levels to ensure that the program messages are being relayed 
consistently and constantly over the project period. 
iii. Consider strategies to support youth who undertake community interactions or awareness events given that they are 
sometimes being asked to put themselves into uncomfortable situations where they discuss difficult topics. 
3) Parent and Caregiver Programs 
i. Programs that work with parents or caregivers as a target group need to have a specific skills-based curriculum or 
organized set of activities for this group. 
ii. Curricula for parents or caregivers need to be translated into the local languages. 
42
Table A.2. Cross-Cutting Observations from ABY Site Visits 
Observations 
1) There are advantages and disadvantages of solely implementing the program and of partnering with 
other organizations for program implementation. 
a. The advantage of solely implementing the program is the ability to standardize the program 
approach across multiple sites within a country. The disadvantage is that by solely 
implementing the program it is difficult for an organization to take a program to scale. 
b. An advantage of partnering is that the local partners tend to have good ties to the youth in 
the communities they serve, increasing the visibility and trust of the program. Additionally, 
rapid scale-up using multiple implementing partners can facilitate program growth and 
sustainability. A disadvantage of partnering is that leaving activities to local partners can 
result in a lack of standardization of interventions and a lack of clear program identity. 
2) Programs are implemented within churches, schools, and communities. 
a. Faith-based partners working with churches had greater success if they worked within their 
own church and offered church leaders a training or orientation to the program. 
b. School-based programs were stronger if they had the support of the ministry of education. 
c. An advantage of working in community settings is the opportunity to reach a broad audience, 
including high-risk youth. 
d. Many programs are implemented in multiple settings to affect individual youth (e.g., schools 
and churches) and the environment within which they live (community-based activities). 
3) Both direct and indirect reach are important, the first to increase skills of participants and the second 
to change the environment within which youth live. 
4) Undertaking skills-based programming (e.g. condom negotiation skills and communication strategies) 
with high risk youth can lead to greater long-term impacts than programs that consistently work with 
low-risk youth in school-based or church-based settings. 
5) Organizations need to work with their USAID point of contact to determine what strategies and 
messages are permissible under the Emergency Plan ABC Guidance for programs implemented with 
AB funding. 
43
Appendix B. Countries Where ABY Partners Are Supported to Work 
ADRAAmerican Red Cross CRSCAFFood for the Hungry Fresh Ministries HOPE WW IYFPACT, Inc PATHSalesian Missions Samaritan's Purse World Relief World Vision
Botswana X
Cote D'Ivoire X
Ethiopia XX X X
Guyana X
Haiti XX XX
Kenya X X XX X X X
Mozambique X X XX
Namibia X
Nigeria XX
Rwanda X X
South Africa X XX X
Tanzania XX X X X
Uganda XX X X X
Vietnam
Zambia X XX
ADRA – Adventist Development and Relief Agency 
CRS – Catholic Relief Services 
CAF – Children’s AIDS Fund 
HOPE WW – Hope Worldwide 
IYF – International Youth Foundation 
44
45
Appendix C. Participants in Expert 
Meeting 
Youth Experts 
Susan Adamchak, Consultant 
Stella Babaloba, JHUCCP 
Pam Bachanas, CDC 
Holly Burke, FHI 
Nicole Haberland, Population Council 
Rebecca Maynard, University of Pennsylvania 
Tobey Nelson, Population Council 
Leslie Raneri, OPHS, DHHS 
Jim Rosen, Consultant 
Gary Svenson, FHI 
Ricardo Vernon, Population Council 
Partners and Affiliates 
Jennifer Boyle, JHU (with World Vision) 
Emily Chambers, Samaritan’s Purse 
Christine Connor, JHU (with Samaritan’s Purse) 
Kim Cutler, Food for the Hungry 
Roger Dickenson, Hope Worldwide 
Fe Garcia, World Vision 
Debbie Herold, ADRA 
Joan Leavitt, PACT 
Rachel Lucas, American Red Cross 
Joanna Mayhew, World Relief 
Alex Marcus, Children’s AIDS Fund 
Abbie Mathis, Fresh Ministries 
Lisa Mueller, PATH 
Ricardo dos Santos e Silva, Salesian Missions 
Lorna Tumwebaze, IYF 
Alex Vu, JHU (with Samaritan’s Purse) 
Damilola Walker, Children’s AIDS Fund 
USAID/OGAC 
Michael Cassell 
Shanti Conly 
Shannon Darcy 
Corina Gardner 
Megan Gerson 
Rebekah Krimmel 
Jeanne Monahan 
Megan Petersen 
MEASURE Evaluation 
Shelah Bloom 
Karen Foreit 
Karen Hardee 
Edward Kunyanga 
Carla Lopez 
Nancy Murray 
Ilene Speizer 
 
46
Appendix D. Summary of ABY Expert Consultation Meeting, June 5-6, 2006 
The meeting started with introductions of participants, which included representatives from all 
but one of the ABY Track 1 funded partners (13 out of 14), USAID CTOs, and invited experts 
from cooperating agencies. Michael Cassell gave a brief overview of why we care about 
improving ABY programs (i.e., given that large sums of money are going to new partners for 
new types of programs, it is crucial to understand how to strengthen programs). Michael 
Cassell also discussed that 1) rarely is good process information on program implementation 
characteristics obtained and 2) an understanding of what makes for stronger programs can help 
to strengthen the design and selection of future ABY programs at the partner and funding 
levels. 
Corina Gardner from USAID presented on the Track 1 ABY programs. This included a 
description of types of organizations funded, locations where programs are working, types of 
activities, expected outcomes, and Emergency Plan indicators. Ms. Gardner also provided her 
observations from the field on challenges encountered in the funded programs. These 
challenges included: 1) slow implementation in some cases; 2) reporting (over or under 
emphasis on targets; wide range of interpreting a person reached; multiple managers); 3) 
stereotypes surrounding ‘abstinence’; 4) question of curriculum and best practice (very little 
cross-fertilization); 5) Emergency Plan requirements can challenge best practices. Ms. 
Gardner’s observations included: 1) programs being overly focused on quality of curriculum 
and not enough on training; 2) the importance of engaging leadership to address male 
behaviors; 3) mass media messages should be designed to discourage risky behaviors 
(transgenerational sex, cross generational sex, violence); 4) parents are not being used as an 
integral part of the program; 5) tendency to have programs that are either too message focused 
or too activity focused — need balance. 
Two of the funded ABY partners presented descriptions of their programs. First Ricardo dos 
Santos e Silva from Salesian Missions presented on their program. Second Kim Cutler from 
Food for Hungry presented on their program. These two presentations emphasized program 
successes and were less detailed on program strategies and characteristics. The information 
provided gave some context within which we could discuss youth programming. 
Ilene Speizer presented a description of the framework for the ABY programs and results from 
pilot testing in Haiti. This was her opportunity to present the objectives of the process and 
outcome evaluations and to provide clarity on the meeting objectives — to help to determine 
what needs to be measured during site visits with the partners to assess program quality and 
intensity. The information from the site visit was useful for providing additional context of 1) 
the utility of the site visits, and 2) levels of programming that need to be considered at the 
program evaluation phase. 
Karen Hardee led a discussion of the conceptual frameworks and what is missing from the 
framework. Based on this discussion, the overall conceptual framework for the process 
evaluation of the ABY programs was modified to address gaps. This led nicely into the 
afternoon working groups on strategies for youth programming. 
 
47
After lunch (day 1), we broke into small groups to discuss components of stronger and more 
intense youth programming. Groups were 1) organizational environment and 
community/church involvement; 2) adult led programs; 3) peer education; and 4) mass media, 
community mobilization, and parent child programs. 
The moderators were meant to obtain an extensive list of areas to consider when undertaking a 
process evaluation. The findings were useful for either affirming areas covered in the pilot 
version of the tools or identifying additional areas that needed to be considered in modified 
tools. One key finding was that leader-based programs (peer-led, adult-led, in school, out of 
school, church, etc.) are probably more similar than different. Some leaders may be targeting 
different groups (youth, adults, influencers) that may make their activities or 
curriculum/messages different but the characteristics of effective programming is probably 
similar across the different leader-based programs. 
Day 2 started with a discussion of the outcome evaluation. This was an opportunity for the 
experts to provide input on the design. What came out of this discussion was that if the 
outcome evaluation can not be done with a strong design (baseline/follow-up; intervention and 
comparison sites; ideally some random site selection), then it is probably not worth the 
expense. Dr. Speizer acknowledged that while in the field in June/July the objective is to 
determine the feasibility of the outcome evaluation in Kenya and Mozambique. The group 
suggested focusing on Mozambique where there are fewer other programs underway and 
greater potential for attribution of behavioral change to the Emergency Plan ABY activities. 
During the second day, the group approved the conceptual framework and discussed the 
summary of findings on leader-based programs that came out of the first day of meetings. We 
discussed in more depth what is community mobilization and what makes a stronger 
community mobilization (and mass media) program. This was a helpful discussion given that 
the interpretation of community mobilization varies and there is a continuum from low 
community involvement (mobilization) to complete involvement (activities led by the 
community). 
The meeting concluded with an acknowledgement of the valuable input provided by the 
experts. The recommendations by the experts to strengthen the process evaluation (i.e., include 
observations, visit more sites, spend more time in field, etc.) are important strategies that 
indicate 1) that the process evaluation is considered a necessary step for program improvement, 
and 2) ways to strengthen the process evaluation if the outcome evaluation ends up becoming a 
smaller endeavor. 
 
48
Appendix E. Assessment Tool of Youth Reproductive Health Programs 
The following tool is meant to help in process evaluations of youth programs. It was 
developed based on an extensive review of the published and unpublished literature on youth 
reproductive health programs and an expert consultation meeting that included 30 experts from 
the field of adolescent reproductive health programs (funding institutions, implementers, and 
evaluators) as well as from input of 20 people currently involved in implementing abstinence 
and partner reduction programs with USAID funding. While the tool was originally designed 
for the process evaluation of Abstinence and Be Faithful for Youth (ABY) programs, it has 
been modified to serve a wider audience. While each question has a yes/no option, more 
important are the comments and input that are received. It should be noted that many of the 
questions will not be relevant to all programs in all settings. 
The tool has been designed in the following sections: 
• Organizational Preparedness 
• Community Involvement 
• Role of Religious Partner 
• Components of Successful Youth Programming 
• Facilitator Led Activities 
• Parent/Caregiver/Influencer Activities 
• Mass Media and Community Mobilization 
• High Risk Populations 
• Evaluation Issues 
Some key definitions that are important for using this tool include: 
1) Who are the beneficiaries and participants? The beneficiaries are generally the 
program’s key target audience, which for most adolescent reproductive health programs 
is all youth (in some location). That said, programs that target high risk youth (e.g., 
formal or informal sex workers, orphans and vulnerable children) likely have different 
groups of beneficiaries. Participants are considered to be those who benefit from the 
program directly and are from the beneficiary population. In addition, in cases where 
programs target the wider community including village leaders, parents and other adult 
influencers, or religious leaders, the participants may include adults. Even in cases 
where program participants include a wider audience, the underlying objective of the 
programs is still usually to have secondary effects on youth outcomes (the 
beneficiaries). 
2) Who are the facilitators or leaders? These terms are used interchangeably throughout 
this tool. Generally, these are the individuals who deliver the program to participants 
and beneficiaries. These can be program staff, trained teachers, trained peer educators, 
or trained community-lay people. 
3) What is a curriculum and how does it differ from a training manual? While there are 
no clear-cut definitions of these two terms, in this document, the curriculum is referring 
to a structured program that is delivered to participants or beneficiaries. A manual (or 
training manual) is referred to in this document as materials (often a formal curriculum) 
 
49
that are used to train the trainers or the facilitators/leaders. In some cases, the same 
manual (curriculum) is used to train facilitators as what they use with their participant 
groups. 
How to Use this Tool 
The tool provides numerous questions about each program area. Next to each question is a 
coding scheme of whether the question is relevant to the organization’s experience, to project 
design, to training of staff/facilitators, to program implementation, or to potential sustainability 
of the program (Experience, Design, Training, Implementation, Sustainability). This 
classification scheme is useful for the evaluator as she reviews a program to ensure that 
questions are relevant to the appropriate program component. This scheme is also meant to be 
useful to a program developer who uses this tool at the early stages of their program (and 
ideally at the proposal development stage) to ensure that they consider key areas early on. 
Sustainability refers to both programmatic and financial sustainability of a program. In 
particular, there are questions to determine whether the community accepts the program and is 
being trained to implement the program (programmatic sustainability) and questions on 
whether the community provides support (in-kind or financial) to the program (financial 
sustainability). Both programmatic and financial sustainability are important if a program is 
meant to last beyond the funding period. 
Finally, the current version of the tool has some italicized comments that are included in the 
‘Comments’ section. These comments are meant to help the person using the tool understand 
why these concepts or questions are important. If the tool is to be used in a process evaluation, 
the existing comments in this column should be deleted and this space should be used to input 
information about the program on each question. 
50
PART A: ORGANIZATIONAL PREPAREDNESS
No/Yes 
Comments/Notes 
Experience, 
Design, 
Training, 
Implementation 
Sustainability 
A1) Independent of this project, does your organization 
have an explicit mandate to serve youth? 
 If yes, what age groups ____________________ 
E 
A2) How many years has your organization been working 
with youth? ______________ 
E 
A3) Has your organization worked in your target 
communities previously? How long? 
Experience in the community suggests greater understanding of 
the cultural context of environment 
E 
A4) Does your organization have a long-range plan to serve 
youth (three to five years)? 
A long-range plan to serve youth is suggestive of greater 
potential for sustainability of program goals 
S 
A5) Does your organization have youth who provide input 
and advice on program design? 
Youth can be involved at multiple stages to ensure program 
acceptability 
D 
A6) Are you implementing the majority of your project 
activities? If not, are you partnering with other 
organizations to implement some activities or are you 
exclusively funding other organizations to implement 
activities? 
If solely implementing the program, skip to A10 I 
A7) How long have your partners been working in the 
communities? _____________________ 
Experience in the community implies that partners have 
established contacts, goodwill, and increased likelihood of the 
community acceptance. 
E 
A8) How long has your organization been working in this 
partnership? 
Illustrates experience of lead organization as a leader with its 
partners 
E 
A9) If the organization has sub-grantees… 
How many organizations implement activities with your 
organization’s funds? ___________________ 
On a scale from 1-3, how involved would you say your 
organization is in the design of each sub-grantee’s 
program activities? (describe involvement) 
Does each organization use a different curriculum? 
Does your organization provide training to the sub￾grantees on ABY program strategies? 
How often do you meet with each sub-grantee? 
This provides a perspective on the number of partners and role 
of the lead organization on the activity 
I 
A10) Are you leveraging other funds for this project? 
A11) Are you familiar with the U.S. Government ABC policy? It may be worthwhile to ask if the partner understands and/or 
needs guidance on how to interpret 
E 
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PART B: COMMUNITY INVOLVEMENT 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
B1) Is the community involved in a consultative role, 
actively participating, or not involved at all? 
Not involved at all 
Consultative role 
Actively involved 
Community involvement is crucial at all phases of a 
project for program acceptability and long-term 
sustainability 
S 
B2) Was a needs assessment in the community done prior 
to program design/implementation? 
How about after implementation began? Is it still 
possible to do one? 
Many organizations have experience working in communities, 
but have no specific data to inform their activities – needs 
assessments are helpful for tailoring the program to specific 
community needs 
E/D 
B3) Did you have any formal meetings with community 
leaders and/or members prior to program 
implementation? 
This gets local stakeholder involvement and can happen in 
various ways 
D 
B4) Since the program has begun, have you had any formal 
meetings with community leaders and/or members? 
 If yes, when was the last meeting? 
This determines if the stakeholders are being kept up to date on 
continued progress and ensures accountability to the 
stakeholders 
I 
B5) Do you include capacity building of local groups as part 
of the program strategy? 
If yes, list areas included in capacity building activities 
(e.g., management, M & E, TOT, etc) 
This determines if the community is gaining by this activity in 
terms of skills that can be used for future programming 
S 
B6) Do you get in kind or financial support from the 
community to implement your project (e.g., facilities, 
personnel, transportation, etc.)? 
This demonstrates community support of the program and 
potential long-term sustainability 
S 
B7) Are there referral mechanisms between your program 
and community resources? 
This is not required, but reduces the burden on the organization 
to provide all the relevant services and makes the program more 
cost-effective 
I/S 
52
PART C: ROLE OF RELIGIOUS PARTNER 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
C1) Did you have any formal meetings with church leaders 
and/or members prior to program implementation? 
This gets local stakeholder involvement and can happen in 
various ways 
D 
C2) Since the program has begun, have you had any 
formal meetings with church leaders and/or members? 
 If yes, when was the last meeting? 
This determines if the stakeholders are being kept up to date on 
continued progress 
I 
C3) Does the church provide in kind or financial support to 
the project (e.g., facilities, personnel, transportation, 
etc.)? 
This demonstrates church support of the program and potential 
long-term sustainability 
S 
C4) Do you include capacity building of church partners as 
part of the program strategy? 
If yes, list areas included in capacity building activities 
(e.g., management, M & E, TOT, etc) 
If yes, list levels of the church receiving capacity 
building (e.g., partner institution, local dioceses, 
individuals 
This determines if the church community is gaining by this 
activity in terms of skills that can be used for future 
programming 
S 
C5) Are project messages delivered through any of the 
following channels: 
• Youth groups? 
• Sermons? 
• Parent education? 
• Sunday school teachers? 
• Orphanages? 
• Other? ________________________ 
I 
C6) Does the project provide materials for use by church 
leaders for incorporating the messages into sermons 
and teachings? 
I 
C7) Does the church target any youth outside of the church 
setting? 
If yes, where are you finding these non-church linked 
youth? 
This increases program reach beyond the walls of the church I 
C8) Do the project activities build on previously existing 
activities for youth in the church? 
This assesses church experience with HIV prevention E/I 
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PART D: COMPONENTS OF SUCCESSFUL YOUTH PROGRAMMING 
Part D – Components of Successful Youth Programming: This section is generally about your ABY program. Specific questions about ABY 
strategies are in a separate section. 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
Program Design & Development:
D1) What do you hope to accomplish during the funding 
cycle? 
 Vision 
D2) Can you quantify for me what your projects goals and 
objectives are? (ask if not quantified in D1)
 S 
D3) How did you select the specific activities you are doing 
to obtain the above goals and objectives? 
 D 
D4) What is special or different about the prevention 
program you are implementing? 
 D 
D5) Was a logic model developed to determine what 
activities to undertake within your prevention program? 
D 
D6) Has youth reproductive health been part of your 
organization’s program strategy prior to this funding? 
If yes, how long have you been working on these 
issues? 
If yes, give examples of prior activities 
E 
D7) Has HIV been part of your organization’s program 
strategy prior to this funding? 
How long? 
E 
D8) Were youth involved in: 
 Developing program objectives? 
 Determining appropriate activities? 
D 
D9) Does the project have a plan for sustainability? 
If yes, what is planned? 
Does the plan include programmatic and financial 
plans? 
An organization needs to consider financial and programmatic 
sustainability issues from the outset to ensure that there is a long￾term plan 
S 
D10) Do you have information on other programs for youth 
(generally and/or specifically in HIV/AIDS) in your 
catchment areas? 
Need to know who is working in the communities to reduce 
duplication and strengthen overall programs for youth 
D/S 
54
Part D – Components of Successful Youth Programming: This section is generally about your ABY program. Specific questions about ABY 
strategies are in a separate section. 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
55
Section E – these questions are asked specifically for facilitator-led programs. This includes programs that are led by program
staff, a teacher, a Sunday school teacher, a scout leader, a peer educator, or a health educator. The facilitator is the person 
leading the program with a youth (or parent/adult) group. The trainer is the person who trains the facilitator. In some cases, 
the trainer also works with youth (or parent/adult) groups. In this case, the trainer becomes a facilitator. 
To begin, we need to know what activities are included in your ABY program (this information determines if they need to complete this section on 
facilitator-led programs). 
Mark all that apply: 
• Peer education 
• Adult-led (school-based; scouting-based; church) 
• Mass media (be sure to complete Mass Media section)
• Parent/Caregiver/Influencer (be sure to complete the Parent/Caregiver/Influencer section)
• Community mobilization (be sure to complete the Community Mobilization section)
PART E: FACILITATOR-LED ACTIVITIES MODULE 
Part E— Facilitator-led activities: (includes scouting, school-based, church-group based, peer education, etc.) – Activities led by adults or 
youth generally for youth participants or beneficiaries 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
E1) Who is the facilitator of your program? 
• Youth facilitator (peer education) 
• Adult facilitator 
o Teacher 
o Sunday school teacher 
o Scout leader 
o Program staff 
o Health educator 
o Other ______________________ 
Fill out this form for each type of leader, if they are doing different 
activities 
D/I 
E2) Are the facilitators in your program trained? 
 If yes, how long does the training last? 
 ________(# hours) 
 ________(# days) 
 Who trains the facilitators? ____________________ 
Training ensures standardization of program strategy across each 
facilitator 
T 
E3) Are training needs of facilitators assessed prior to 
undertaking training? 
 If yes, is the training modified based on needs 
assessed? 
By designing a training that not only ensures basic competency but 
also focuses on specific needs of facilitators, the training program 
will be more useful for the facilitators 
T 
E4) Is there a training manual used to train facilitators? 
(request training manual) 
Important for ensuring standardization of messages T 
56
Part E— Facilitator-led activities: (includes scouting, school-based, church-group based, peer education, etc.) – Activities led by adults or 
youth generally for youth participants or beneficiaries 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
E5) Are facilitators trained about sexual abuse and how to 
refer those with problems? 
Often a gap in training that is becoming increasingly important to 
fill 
T 
E6) Does the training for facilitators include: 
a) accurate and adequate knowledge and skills to teach 
about and answer questions related to the content of 
the curriculum e.g., HIV transmission and prevention, 
puberty, STD symptoms, etc.)? 
b) practice using the teaching strategies included in the 
curriculum (e.g., role playing, leading group 
discussions, etc.)? 
c) opportunities to build facilitators’ confidence in 
communicating about sexual content and responding to 
sensitive questions? 
d) opportunities for facilitators to acknowledge and 
address their own biases about adolescent sexuality? 
e) the importance of implementing each of the lessons in 
the curriculum? 
a) check this using the manual – does not need to be asked 
T 
E7) Are facilitators trained on gender issues including 
gender norms, cross-generational relationships, 
transactional sex? 
T 
E8) Are facilitators trained on how to protect privacy and 
confidentiality of their contacts? 
T 
E9) Are facilitators trained on conflict resolution? T 
E10) Are facilitators trained on how to monitor (keep track of) 
their contacts? 
T 
E11) Are there criteria for determining whether facilitators 
have basic competency upon completion of training? 
This provides the program an opportunity to ensure that all trained 
facilitators know how and what to present 
T 
E12) Do you have refresher training for facilitators after initial 
training? 
This does not only help facilitators get updated on material but also 
provides an opportunity to for them to learn about topic areas that 
are raised in the field. This refresher training should happen at 
least annually 
T 
E13) How many facilitators have been trained to date? 
How many facilitators have received refresher training? 
T 
E14) Does the program include both male and female 
facilitators? 
D 
E15) Do facilitators represent culturally the youth they serve? D 
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Part E— Facilitator-led activities: (includes scouting, school-based, church-group based, peer education, etc.) – Activities led by adults or 
youth generally for youth participants or beneficiaries 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
E16) Are facilitators volunteers? Programs that rely on volunteers may be more sustainable, however 
there are limits on how much time volunteers have 
D/S 
E17) Are facilitators paid staff? Programs that use paid staff as facilitators may have more 
consistent messages but may not be sustainable after funding 
D/S 
E18) Do you provide incentives to facilitators including 
monetary or non-monetary incentives (if yes, list in 
comments types of incentives)? 
This is important to help encourage facilitators to stay in the 
program once they are trained which may lead to greater long-term 
sustainability 
S 
E19) Do facilitators receive allowance, meals, and 
transportation? 
I/S 
E20) Are facilitators undertaking any activities directly with 
parents and other adult care-givers? 
If yes, were facilitators trained to work specifically with 
parents or adults? 
If yes to this question, be sure to complete the section on 
parent/caregivers programs. Skills to work with youth are not 
always applicable to older ages 
D 
E21) Are parents and other adult care-givers kept informed 
of the topics being covered with their children during 
the program? 
I/S 
E22) Do facilitators have different messages or activities for 
different target groups? 
This determines if the program uses a one-size-fits all approach or 
targets groups with different approaches 
I 
E23) Do facilitators have specific target groups they work 
with? (mark all) 
• Scouts/scouting type group 
• School children 
• Church groups 
• Sporting groups 
• Out-of-school youth 
• Orphans 
• Domestic workers 
• Refugees 
• Other (specify) _____________________________ 
D 
E24) Do any of the facilitator-led activities take place in a 
school setting? 
If yes: 
a) Is it part of the regular school day? 
b) Is it required for all students? 
c) Do participants self-select in to the program? 
These questions are important to better understand whether the 
target audience is self-selected, if it is required to participate, and in 
what type of school-based setting they are receiving the program. 
This will help understand the potential for effectiveness of a 
program. 
I 
58
Part E— Facilitator-led activities: (includes scouting, school-based, church-group based, peer education, etc.) – Activities led by adults or 
youth generally for youth participants or beneficiaries 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
d) Does the program take place in an after-school 
group? 
e) Is it part of an existing class (e.g. health, science)? 
f) Are activities open to youth who are not students? 
g) Does it take place in a private or religious school? 
h) Takes place in a government school setting? 
E25) Is there a clearly defined supervision structure of 
participating facilitators? (describe) 
Facilitators need to be supervised and mentored to ensure 
they are comfortable with material & approach 
I 
E26) How often do supervisors monitor facilitator contacts? 
Do supervisors observe facilitators leading a group? 
Do supervisors check accuracy of material presented? 
I 
E27) Does the project have forms to track facilitator 
contacts? 
Do the forms record which lessons are taught? 
Do the forms count the number of participants at each 
session? 
Do the forms indicate the number of participants 
continuing? 
Do the forms indicate how many participants complete 
the program? 
Were facilitators trained on the use of the forms? 
These forms provide a perspective of reach of the program 
and the intensity of the messages and approaches undertaken 
I/T 
E28) Do you undertake regular meetings with trained 
facilitators? 
 If yes, how often do these meetings occur? 
 If yes, what are the objectives of the meetings? 
I/S 
Content
E29) Are the following topics covered in your facilitator-led 
program: 
a) Abstinence? 
b) Fidelity in relationships? 
c) Voluntary counseling and testing? 
d) Peer pressure and teach refusal skills? 
e) Focus on values (e.g., responsibility, self-control, 
self-respect, and respect of others)? 
f) Messages on condom use? 
g) Messages on cross-generational sex (to appropriate 
If a curriculum exists, this can be checked for specific topics 
instead of asking each question 
D 
59
Part E— Facilitator-led activities: (includes scouting, school-based, church-group based, peer education, etc.) – Activities led by adults or 
youth generally for youth participants or beneficiaries 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
audiences)? 
h) Issues of sexual abuse and rape? 
i) Risks associated with transactional sex? 
j) Gender norms (list activities if doing)? 
k) Parents as a resource for youth? 
l) Outreach activities with PLWHA 
Delivery
E30) Do the facilitator-led activities include a variety of 
activities to keep youth engaged (e.g., role playing, 
small groups, drama)? (list activities) 
I 
E31) Are there self-contained lessons for youth participants? 
If yes, how many lessons are youth participants meant 
to get? 
How often do facilitators meet with the same group of 
youth? 
D/I 
E32) How many contact hours between facilitators and 
participants does the program recommend? 
This determines the intensity of the program strategy I 
E33) What is the ratio of facilitators to participants? (on 
average) 
I 
E34) Do facilitator-led programs include mechanisms to 
encourage anonymous questions and discussion? 
I 
E35) Do the facilitator-led activities happen in locations 
comfortable for youth participation? Where? 
I 
E36) Do mechanisms exist to protect confidentiality of 
participants (i.e. confidential group discussions, and 
abstinence pledges)? 
I 
E37) Do you have a clearly defined system to refer 
participating youth for services not offered by your 
program (condoms, VCT, pregnancy testing)? 
This makes a program have a greater reach in a cost-effective 
manner 
I 
E38) Are participants asked to do an outreach activity with 
their peers? 
If yes, what kind of activity? 
If yes, are participants monitoring their contacts? 
This type of activity increases the potential reach of the 
program beyond the smaller target group 
I 
E39) Are facilitators provided with reference materials to use 
with beneficiaries (youth or other beneficiaries)? 
Reference materials can supplement the material in a curriculum 
and be used to ensure that facilitators have a reliable source of 
standardized information to answer difficult questions 
I 
60
Part E— Facilitator-led activities: (includes scouting, school-based, church-group based, peer education, etc.) – Activities led by adults or 
youth generally for youth participants or beneficiaries 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
E40) Are facilitators expected to train groups to become 
future facilitators? 
Without adequate monitoring and supervision, the 2nd and 3rd￾level trained facilitators are often less effective than those who 
were trained by expert trainers. 
I/S 
Curriculum
E41) Are facilitators expected to present material using a 
specific curriculum? 
If not, skip to next section D 
E42) Was the curriculum selected based on the development 
of a logic model? [obtain copy of logic model] 
If a logic model was not developed, it may be worthwhile to 
recommend the creation at this point (to learn more about 
logic models, go to the free online monitoring and evaluation 
training at: www.cpc.unc.edu/measure/training/MENTOR
D 
E43) Does the program rely on an evidence-based 
curriculum (i.e., previously tested and shown to be 
effective)? 
E/D 
E44) Was this a curriculum that was previously used with 
youth for AB/RH programming in this country? 
E/D 
E45) Was the curriculum pilot-tested/ 
 If yes, were modifications made based on the pilot test?
E/D 
E46) Were youth involved in curriculum design/modification? D 
E47) Were facilitators involved in curriculum 
design/modification? 
D 
E48) Was the curriculum modified to meet specific 
characteristics of the local population, including using 
language/words that youth understand? 
This ensures that the program will be better accepted by the 
target youth 
D 
E49) Was the curriculum translated into the local languages 
that are used in the intervention communities? 
This helps with standardization and avoids facilitators 
interpreting the curriculum on their own and differently 
D 
E50) Was the curriculum modified by your project for any of 
the following target audiences: 
a) Youngest youth (10-14)? 
b) Older youth (20-24)? 
c) In-school youth? 
d) Out-of-school youth? 
e) Rural youth? 
f) High-risk youth? 
D 
E51) Does the curriculum have a reference guide or 
frequently asked questions section for use by 
facilitators? 
This helps to standardize the responses to difficult questions 
that may not be addressed in the curriculum 
D 
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Part E— Facilitator-led activities: (includes scouting, school-based, church-group based, peer education, etc.) – Activities led by adults or 
youth generally for youth participants or beneficiaries 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
E52) Do facilitators have the option to choose what to 
present? 
If yes, is there a plan for coverage of material that the 
facilitator chooses not to present or is 
uncomfortable presenting? 
I 
IF THE FACILITATOR-LED PROGRAM IS ADULT-LED, ASK THE 
FOLLOWING QUESTIONS 
E.A.1) Do you have a screening mechanism to ensure that 
each adult leader has no history of child abuse? 
D 
E.A.2) Do you select adult leaders who are connected to the 
youth in the community? (Describe selection 
procedures in comments/notes) 
D 
Section F - IF THE FACILITATOR-LED PROGRAM IS PEER￾LED, ASK THE FOLLOWING QUESTIONS 
F1) Are there clearly defined criteria for selection of peer 
educators? (describe selection procedures in 
comments) 
Do the criteria include any of the following: 
• Age restrictions? 
• Marital status? 
• Modeling behaviors? (Which ones?) 
• Motivations? 
• Ability to relay messages? 
D 
F2) Do you use a nomination process to identify eligible 
PEs? 
If so, by whom are they nominated? 
D 
F3) Are new peer educators trained before starting program 
activities? 
T 
F4) Does the project have ways to track the number of PE 
trained? 
The number retained? 
The number dropped out? 
I 
62
Part E— Facilitator-led activities: (includes scouting, school-based, church-group based, peer education, etc.) – Activities led by adults or 
youth generally for youth participants or beneficiaries 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
Do you obtain reasons for dropping out among PE? 
F5) Do you have strategies to encourage PE retention 
including: 
a) Working with PE to design a manageable workplan? 
b) Providing technical and emotional support for PEs? 
c) Giving PEs responsibility and decision-making power? 
d) Creating personal and professional growth 
opportunities? 
e) Assuring access to program materials and information? 
f) Undertaking advanced workshops for trained PE? 
g) Providing certification of training at each stage? 
h) Using advanced PEs to train new PEs? 
I/S 
F6) Are less experienced PE partnered with more 
experienced PE? 
T 
F7) Do PE undertake small group sessions with 
participants? 
If yes, is each small group session focusing on a 
specific lesson? 
How many times does each small group meet with the 
PE? 
How often do PE conduct sessions with groups? 
What is the ratio of PE to beneficiaries in groups? 
Where/when are you undertaking small group 
sessions? 
• During school day 
• After-school 
• Church 
• Community center 
• Youth center 
• Other ____________ 
Are groups formed specifically for program activities? 
Does the group have regular/formal meetings? 
Most PE activities take place in group settings. In some 
cases, peer educators are implementing a formal curriculum 
with their peers and in others, they are only meant to act as 
role models. Generally, if peer educators can work with 
established groups that have regular meetings, they are more 
likely to have an attentive, regular audience. Where groups 
are formed specifically for the peer educators, the groups 
meet less regularly and are less committed to the program. 
I 
F8) Do PE undertake one-on-one sessions with 
beneficiaries and/or beneficiaries? 
If yes, are PE meeting with the same youth for several 
one-on-one sessions? 
In some cases, peer educators are meant to interact with their 
peers through one-on-one sessions. These tend to be more 
focused sessions, identifying how the program can be tailored 
to the youth’s own behaviors. These tend to be unstructured, 
I 
63
Part E— Facilitator-led activities: (includes scouting, school-based, church-group based, peer education, etc.) – Activities led by adults or 
youth generally for youth participants or beneficiaries 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
Are PE meant to provide specific lessons according to 
a script or curriculum within the one-on-one 
sessions? 
How many sessions should PE have with one-on-one 
beneficiaries? 
Are PE keeping track of how often they meet with the 
same youth? 
How are PE identifying their 1 -1 contacts? 
Where are PE undertaking their 1-1 contacts? 
• School 
• Church 
• Youth group 
• Community center 
• Youth center 
• Other ____________________ 
with less standardized material/issues covered 
F9) Does the project use trained peer educators to 
undertake community mobilization activities? 
(Community Mobilization: community-level activities 
that have the objective of gaining sustained 
involvement from the community) 
 If yes, what types of activities? 
 How often are the activities? 
 What is the approximate number of attendees? 
 Who is the target audience? 
I 
64
PART G: PARENT/CAREGIVER/INFLUENCER ACTIVITY MODULE 
Part G – Parent/Caregiver/Influencer Programs – If the program is undertaking these types of activities, respond to the questions below 
about the specific activity. Note that programs that are using facilitators for the parent-child program will also complete the facilitator-led 
program section above. In this section, there are specific considerations because these programs target adult as the beneficiaries. 
No/Yes Comments/Notes Experience, 
Design, Training, 
Implementation 
Sustainability 
Describe the activity for parents/caregivers/influencers your program is implementing 
Who is the target audience? Parents; caregivers; pastors; teachers; others 
G1) Does your program train facilitators who lead activities 
with parents/caregivers/influencers groups? 
If yes, how long does the training last? ____(# hours) 
 ____(# days) 
T 
G2) Do you use parents/caregivers/influencers as 
facilitators? 
D 
Content
G3) Do facilitators cover the following topics with their 
parent/caregiver/influencer groups: 
a) That communication is more than a one-time talk? 
b) Ways to make talking about tough issues easier? 
c) Risks of cross-generational sex (roles of adults & 
youth)? 
d) Risks of transactional sex (addressing adults as 
 consumers and youth as sellers)? 
e) Prevention of sexual abuse? 
f) Issues of sex and sexuality? 
g) Parenting seminars (broader than AB messages)? 
h) How to be a good role model for youth? 
i) Strategies to encourage youth to remain abstinent? 
If there is a curriculum that the facilitators use with 
parent/caregiver groups, check curriculum for these topics 
I 
Delivery
G4) Do the activities for parent/caregivers/influencers 
include: 
a) Activities to increase parent communication skills? 
b) Strategies to attract parents/caregivers/influencers to 
participate? (describe strategies)
c) Diverse teaching methods? 
d) Being undertaken in locations where 
parents/caregivers/influencers will participate? 
e) Being undertaken at times these people are available? 
I 
65
Part G – Parent/Caregiver/Influencer Programs – If the program is undertaking these types of activities, respond to the questions below 
about the specific activity. Note that programs that are using facilitators for the parent-child program will also complete the facilitator-led 
program section above. In this section, there are specific considerations because these programs target adult as the beneficiaries. 
No/Yes Comments/Notes Experience, 
Design, Training, 
Implementation 
Sustainability 
f) Activities for parents/caregivers/ and youth together? 
g) At least 5-10 contact hours? 
 What is the ideal number of contact hours? 
 What is the typical number of contact hours? 
G5) Does the parent or parent/caregiver/influencer 
program involve more than one interaction with target 
audience? 
If yes, how long is the intended contact period: 
 Number of sessions? 
 Duration of each session? 
 Total intended number of contact hours? 
I 
Curriculum
G6) Does your program have a specific curriculum to use 
with parents/caregivers/influencers? (get copy)
D 
G7) Who designed the curriculum you are using? E 
G8) Was the curriculum selected based on the 
development of a logic model? [obtain copy] 
If a logic model was not developed, it may be worthwhile to 
recommend the creation at this point 
E 
G9) Is the curriculum considered evidence-based (i.e., 
previously tested and shown to be effective)? 
E 
G10) Was this a curriculum that was previously used in this 
country? 
E 
G11) Was the curriculum pilot-tested? 
If pilot –tested, was the curriculum modified based on 
results of the pilot? 
E/D 
G12) Were parents/caregivers/influencers involved in 
curriculum design/modification? 
D 
G13) Was the curriculum modified to meet specific 
characteristics of the local population, including using 
appropriate language/words that parents understand? 
This ensures that the program will be better accepted by the 
target parent/caregivers/influencers 
D 
G14) Was the curriculum translated into the local languages 
that are used in the intervention communities? 
This helps with standardization and avoids facilitators 
interpreting the curriculum on their own and differently 
D 
66
PART H: TRAINING OF TRAINERS 
Part H – This section is specifically about the training of trainers and key program staff who will be leading the program 
No/Yes Comments/Notes Experience, 
Design, Training, 
Implementation 
Sustainability 
H1) Are the persons who train facilitators trained as well? 
 If yes, how long does the training last? 
 _______(# hours) 
 ________(# days) 
 Who trains the trainers? ____________________ 
T 
H2) Is there a training manual to train trainers? (request 
training manual)
If not, skip to H4 T 
H3) Does the training of trainers include: 
f) Accurate and adequate knowledge and skills to teach 
about and answer questions related to the content of 
the curriculum e.g., HIV transmission and prevention, 
puberty, STD symptoms, etc.)? 
g) Practice using the teaching strategies in the curriculum 
(e.g., role playing, leading group discussions, etc.)? 
h) Opportunities to build confidence in communicating 
about sexual content and responding to sensitive 
questions? 
i) Opportunities for trainers to acknowledge and address 
their own biases about adolescent sexuality? 
j) The importance of implementing each of the lessons in 
the curriculum 
Check training manual if this exists 
T 
H4) Is there refresher training for trainers? This does not only help trainers get updated on material but also 
provides an opportunity to for them to learn about topic areas that 
are raised by facilitators. This refresher training should happen at 
least annually 
T 
H5) Do the trainers have a regular group meeting or 
debriefing with project administrators? 
 If yes, when was the last meeting? 
T 
H6) Are the trainers paid project staff? This provides a perspective of potential for sustainability T/S 
H7) Are the trainers from another organization? In some cases, when trainers are from another organization, they 
do not receive the training necessary for the specific program they 
are implementing with the lead organization 
T 
67
PART I: MASS MEDIA AND COMMUNITY MOBILIZATION MODULE 
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
I1) Is your organization undertaking or supporting any 
mass media activities? This includes: 
a) Television 
b) Radio 
c) Newspaper articles 
d) Posters 
e) Brochures targeted to youth (e.g., scouting papers) 
f) Other 
If no mass media, skip to community mobilization I 
I2) What are the objectives of your mass media program? 
• Sources of information on: ____________ 
• Promoting a behavior ________________ 
• Other _____________________________ 
There are many objectives of mass media programs and this is the 
opportunity to better understand the program strategy. You can also 
request whether they have a logic model that links the mass media 
strategy to the other activities. 
D 
I3) Was formative research (an assessment) done to 
determine messages for target youth? 
This increases the potential for the messages and channels used to 
be effective for the target audience. 
D 
I4) Did the assessment determine: 
• Desirable behaviors 
• Attractive role models 
• Current information sources among youth 
• Appropriate channels of communication 
• Age, gender, literacy, language of target audience 
• Social norms around A & B 
• Access to media and media habits 
D 
I5) Were youth involved in the design and development of 
media messages? 
D 
I6) Were the mass media activities pre-tested with target 
youth prior to full implementation? 
 If yes, were changes made based on pre-test results? 
D 
Content
I7) Does your mass media program include: 
a) Messages to encourage parent-child communication? 
b) Specific abstinence messages? 
c) Specific being faithful messages? 
d) Messages on condom use? 
e) Specific messages on gender norms 
f) Messages on where to go for reproductive health 
D 
68
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
services (referral) 
Delivery
I8) Do the mass media activities include: 
a) Messages in local languages? 
b) Media forms that youth are most using (what is most 
common among youth?)
c) Presenting messages at times/locations where youth 
will hear and see? 
d) Promotion of peer-educator outreach activities 
e) Promotion of community mobilization events 
I 
I9) Is there a feedback system to update your mass media 
messages? 
I 
Community Mobilization: Community-level activities that have the objective of 
gaining sustained involvement from the community 
I10) Are you undertaking community mobilization events? If not, skip to next section D 
I11) What are the objectives of your community mobilization 
events, are you trying to: (mark all that apply; write 
messages in comments)
• Sensitize community? If so, to what? 
• Change social norms? If so, which ones? 
• Build community capacity? If so, to do what? 
• Empower community? If so, to undertake what? 
• Other ____________________________ 
There are many objectives of community mobilization activities and 
this is the opportunity to better understand the program strategy. 
You can also request whether they have a logic model that links the 
mass media strategy to the other activities. 
D 
I12) What kind of community mobilization events are you 
undertaking? (e.g., sporting events, drama, etc.) 
 D 
I13) To what degree are activities led/instigated by the 
community vs. your (or your partner) organization? 
• All lead organization 
• Some lead organization, some community 
• All community 
Activities that are led by the community are likely to be better 
able to meet community needs and be sustained for the long￾term 
I/S 
I14) Where do resources come from for community 
mobilization events? 
• Lead organization 
• Partner organizations 
• Lead/partner organizations and community 
• All community 
This relates to potential for sustainability of mobilization events I/S 
69
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
I15) Are activities likely to continue once your organization 
is gone (after funding cycle)? 
 S 
I16) Who initiates community mobilization events?(mark all )
• Politicians 
• Faith leaders 
• Lay community leaders 
• Teachers 
• Peer educators 
• Other ________________ 
 I 
I17) How are community mobilization events linked to other 
project activities? _____________________________ 
A logic model can help to determine program linkages (if a 
logic model exists) 
I 
I18) Are youth involved in design and development of 
community mobilization events? 
 D 
I19) Are youth involved in implementing community 
mobilization events? 
 I 
I20) Are leaders of community mobilization events trained to 
work with youth (e.g., peer educators or adult leaders)? 
 T 
I21) Who is the target audience for community mobilization 
events? 
• Youth 
• Parent/caregivers/influencers 
• Church leaders 
• Community generally 
• Other _____________________ 
 I 
I22) How often are you undertaking community mobilization 
events? 
 I 
I23) Are community mobilization events ever repeated in the 
same community 
 I 
I24) How often are community mobilization events 
repeated? 
 I 
70
PART J: STRATEGIES FOR HIGH-RISK POPULATIONS MODULE - This part was developed for the ABY evaluation but not 
used in the field since only one partner was working in a high risk setting (urban slum) but not specifically with high-risk youth.
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
J1) Is your organization targeting the most at-risk youth 
including 
a. Youth who sell sex for money or material goods 
b. Youth with concurrent sexual partners 
c. Out-of-school youth 
d. Orphans and vulnerable children 
e. Other ___________________(prisoners, specify) 
D 
J2) Was a needs assessment done with high-risk youth to 
determine their specific needs? 
A needs assessment determines what type of program strategies are 
most needed by the target group 
D 
J3) Do you have peer educators working specifically with high￾risk youth? I 
J4) Was the curriculum modified for your high-risk youth 
group? If so, how? (describe)
D 
J5) Do you have special activities to recruit your high-risk 
youth? (describe)
D 
Orphans and Vulnerable Children (OVC)
J6) Does the program have a standardized, measurable 
definition of OVC? (describe in comments section)
 If yes, is this a nationally agreed-upon definition? 
D 
J7) Do you have ways to access those OVC who are 
outside family care settings? 
D 
J8) Do you have ways to access those OVC who are within 
family care settings? 
D 
J9) Do you provide referral services to medical, school￾related, emotional or other material assistance? I 
Content – ask if working with any high-risk groups
J10) Does the program for high-risk youth include: 
a. Addressing other risk-taking behaviors 
including drugs and alcohol? 
b. Specific condom use messages? 
c. Giving information on how to store and use 
condoms? 
d. Opportunities to practice using condom 
negotiation skills 
D 
71
No/Yes Comments/Notes Experience, 
Design, 
Training, 
Implementation 
Sustainability 
J11) Does your program make VCT available to youth either 
by providing the service or referring youth for VCT? 
a. If yes, do youth need parental consent to get VCT? 
b. Where do youth get VCT?____________________ 
I 
Other non-traditional program areas including prevention 
of cross-generational and transactional sex
J12) Does your program undertake specific activities to 
prevent cross-generational and transactional sex? 
Describe activities ____________________ 
 D 
J13) Are activities specifically designed for adult males to 
reduce their involvement in cross-generational and 
transactional sex? 
 D 
J14) Are activities designed to teach young girls about risks 
of cross-generational and transactional sex? 
D 
J15) Do community leaders support the prevention of cross￾generational sex? D 
J16) Do community leaders support the prevention of 
transactional sex? 
D 
J17) Are girls provided with opportunities to make money 
without having to rely on sex work or marriage? 
D 
J18) Are both boys and girls taught about the legal rights of 
women in the country including the definition of rape 
and its legal consequences? 
 D 
J19) Are adults taught about the legal rights of women in the 
country including the definition of rape and its legal 
consequences? 
 D 
J20) Do activities for prevention of cross-generational and 
transactional sex include: 
e. Providing school fees 
f. Teaching refusal skills 
g. Providing information on who to contact if 
inappropriately approached 
h. Other (specify) _________________________ 
 D 
72
Part K – EVALUATION ISSUES 
No/Yes Comments/Notes Experience, 
Design, Training, 
Implementation 
Sustainability 
Does the project have a process to track and monitor 
activities implemented? 
D 
Does the project have a process to monitor if each 
lesson of a curriculum is completed? 
If there is a curriculum I 
Does the project have a mechanism to distinguish 
between direct reach (persons who receive a specific 
curriculum/strategy) from indirect reach (e.g., mass 
media or community mobilization? (describe) 
This provides a perspective of the extent of direct and indirect 
program reach that may be indicative of potential program impacts. 
Does the project have a process to determine which 
youth attend which lessons? 
This measures intensity of program exposure by participating youth I 
Is there a strategy to determine whether messages and 
skills are being relayed beyond participants and into the 
wider audience (e.g., log forms of who communicates 
with whom)? 
This provides a perspective of indirect program reach that may be 
indicative of potential program impacts. 
I 
Do you have an evaluation plan to evaluate program 
outcomes? 
D 
Is there a plan for dissemination and utilization of 
evaluation findings? (describe) 
I/S 
Do you have assessment strategies to identify areas for 
program improvement? 
 If yes, what are you doing? 
I