Ugochi Daniels¹, Audrey Elster¹, Krishna Bose², and Hazel Slavin³. (1) African Youth Alliance, United Nations Population Fund, 220E 42nd St, New York, NY 10017, 212 297 5164, daniels@unfpa.org, (2) Department of Child and Adolescent Health and Development, World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland, (3) Institute for Health Sector Development, 8 Prospect Place, London, United Kingdom

Indicators of behavior change are often used to measure the impact of ASRH interventions. Achieving behavior change requires time, often longer than the life of the program. It is essential to identify intermediate outcomes of behavior change to track progress. For large-scale programs, results achieved vary due to practical challenges of implementation in diverse conditions and environments.

The African Youth Alliance (AYA) program integrates 6 strategic approaches, implemented by over 60 partners in 4 countries of sub-Saharan Africa to improve the ASRH of young people. AYA has used various procedures to operationalize its evaluation strategy: multivariate analysis of baseline data to identify strongest predictors of behavior change to select intermediate outcomes; classification of sites based on integration, quality and duration of implementation, availability of baseline data and level of exposure achieved; 2-tiered evaluation design based on classification (all sites measured at the level of intermediate outcomes but only Class A sites measured at the level of impact).

Lessons learned include: attitudes towards condoms is the strongest predictor of condom use, knowledge of condoms is weakly correlated with use; the evaluation strategy is a mix of measurement approaches; guidelines for site classification are also good planning tools.

Recommendations: the degree to which intermediate outcomes lead to behavioral impact is context-specific and their selection needs to be based on analysis of baseline data. Guidelines for the classification of implementation sites should be developed early as a planning tool for implementing organizations.

Learning Objectives:

• Identify monitoring and evaluating issues that are peculiar to large-scale programs.
• Develop a context-specific methodology to identify intermediate outcomes of behavior change
• Apply practical approaches to address program variablity (inherent in large-scale programs)

Keywords: Adolescent Health, Evaluation

Related Web page: www.ayaonline.org

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.