By: Manish Mitra
Lessons from Pathfinder’s locally led youth programs in India
At Pathfinder, we are committed to locally led programming that is driven by the needs, preferences, and hopes of the people we serve. In this article, we look back on two programs in India that Pathfinder designed with local partners including young people themselves. Our approach in each case ensured local acceptance and impact, broadening youth access to essential sexual and reproductive health services.
Sandeep and Laxmi Awale, a young couple engaged as social entrepreneurs through Pathfinder’s YUVAA project India. Together they delivered contraceptive information and services to the doorsteps of other young couples. Photo credit: Sarah Peck
Sashakt: serving the most marginalized
Our Sashakt program worked with more than 8,000 Mahadalit adolescents in three districts of Bihar state (Purnea, Katihar, and Araria). Mahadalits are a subgroup within the Scheduled Castes, occupying the lowest rungs of the social hierarchy. They often live far from health facilities, lack financial resources, and face stigma from providers and social discrimination more broadly.
Sashakt gave unmarried adolescents sexual and reproductive health and life skills trainings and followed up with monthly peer educator-led group meetings, while married adolescents were trained on healthy timing and spacing of childbirth in addition to receiving home visits by community health workers, referred to locally as Accredited Social Health Activists (ASHAs).
Based on our continual engagement with young people and their communities in the three districts, we made several shifts to how the program was implemented:
- Discrimination: Realizing that health providers tend to be from “upper class” communities and hold deep biases against Mahadalits, we shifted from having one planned provider training to holding a series of trainings meant to encourage inclusive service provision to Mahadalits by reducing bias among health providers. As a result of these trainings, ASHAS’ views of Mahadalits continued to soften throughout the life of the program. However, given the deeply rooted social exclusion of Mahadalits, discriminatory mindsets and practices need to be continually addressed across the health sector.
- Migration: Mahadalit men migrate seasonally to find work. Instead of ASHAs reaching out to couples on their own schedule, we developed a migration calendar with ASHAs to track when husbands return home and ensure access to contraception when sexual activity is most likely. The calendars were designed in local languages with visuals that resonated locally. By the end of the program, the proportion of married women reporting that contraceptive use should be a joint decision between husband and wife rose significantly and 40% of married women and men said they planned to use a method in the next year.
- Literacy: Given low literacy levels among Mahadalit adolescents, we transitioned the tools used by peer educators from lessons to games. Through interactive games, knowledge about contraceptives increased among all adolescent groups involved in the program (married, unmarried, women, men), and 65% of young women and 50% of young men said they believed it was optimal to wait at least two years after marriage to have their first child. The games are now embedded into the government system and used regularly to foster improved sexual and reproductive health among Mahadalit adolescents.
Yuvaa: young social entrepreneurs
Pathfinder’s Youth Voices for Agency and Access (YUVAA) project increased access to and use of modern reversible contraception among young married couples and first-time parents in 10 districts of Bihar and Maharashtra states. While the vast majority of young couples said they intended to use contraception in the future, most were not users when the program began. The program design was based on an in-depth segmentation survey that classified young couples into different groups based on their interest in contraception and social profiles. These profiles drove the design of effectively tailored social and behavior change interventions, including:
- Incentivization through a social entrepreneurship model: We knew that a peer educator-type model, where youth reach other youth with information and services is a best practice we wanted to apply. For sustainability and impact, however, we needed to give youth an incentive to get involved. The 1,200 social entrepreneurs engaged through the program reached more than 400,000 couples throughout the life of the program, driven not just by their goodwill, but also the income they earned. Each social entrepreneur received a product basket that included contraceptives and commonly used household goods that could be sold for a small price while they provided counseling and a safe space for conversations about family planning, childbirth, and social and gender norms.
- Family planning as a lifestyle choice: YUVAA repositioned family planning from a purely health decision to a lifestyle choice, tied to financial benefits and a better life overall. To transmit these messages, the program developed audio and video messages through an Interactive Voice Response platform called Hello Salfal. Pathfinder’s Hello Salfal audio platform reached over 87,534 callers, who spent more than 604,450 minutes listening to content on contraception.
- Digital innovations: Digital platforms like Hello Salfal were integral to program impact. Based on the segmentation survey at the beginning of the program, we knew that most young people had mobile phones, although many of them were not smartphones. When COVID-19 hit, YUVAA built out its digital approaches, including tele-counseling, interactive games, short films that model healthy behaviors, interactive virtual reality tools, and even mobile ‘talking’ projections. YUVAA’s safalcouple.org and Mimo Chatbot provide engaging digital platforms for young couples to learn more, while the m-Pari app strengthens the capacity of providers to support improved client outcomes.
Lessons for locally driven youth programs
We’ve drawn a few lessons from these locally driven youth programs we believe offer value to others in our sector.
Adapting to local needs fosters collaboration and community ownership: As experienced public health professionals, we entered the project communities with initial concepts and best practices designed to drive success. While we adhered to our foundational social and behavior change frameworks, we tailored our strategies to align with the unique profiles and needs of the individuals we aimed to reach. This adaptive approach has led to the sustained use of several platforms, activities, and tools in local communities long after program completion. For instance, the peer educator games developed through Sashakt have gained lasting success in Bihar. The Bihar State Health Society has adopted YUVAA’s digital job aids and the Bihar Rural Livelihood Program has adopted YUVAA’s training materials.
True localization and sustainability require significant investment: Although some components of each program have been sustained locally, comprehensive and lasting sustainability requires dedicated investment. This includes securing funding for extensive advocacy initiatives aimed at encouraging local governments and communities to adopt and prioritize these programs within their policies and budgets. Ensuring lasting sustainability requires more than just allocating resources to integrate program activities into existing systems; it also means extending project timelines to foster transformative change. This includes tackling deeply rooted cultural norms, practices, and beliefs that often hinder progress, particularly in the area of sexual and reproductive health. Without such investments, these programs risk having limited or short-term impact, emphasizing the need for long-term commitment and dedicated resources.
A localized approach evolves: Even when we co-design interventions with local communities, we must remain open to adaptation as programs evolve. Our work cannot remain static, especially in a world where many communities we serve face the pressing realities of climate change, conflict, and economic hardship. To stay effective, our programs must evolve in step with the shifting challenges of our time.
