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SangSangai Facilitator’s Manual
2012
SangSangai Facilitator’s Manual
Published by
Health Sector Support Program (HSSP)
Department of Health Services
Teku, Kathmandu, Nepal
T +977 1 4261404
F +977 1 4261079
E [email protected]
I www.giz.de/nepal
GFA Consulting Group GmbH
Authors
Pushpa Lata Pandey
Jamuna Shrestha Bhattarai
Eva Schildbach
Technical advisors
Kathrin Schmitz
Dr. Christine Winkelmann
Rabindra Karki
Bipul Neupane
Mangala Manandhar
Photo credits
GFA Consulting Group archive
Layout/Design
kiirtistudio
Kathmandu, September 2012
Disclaimer
The views and ideas expressed herein are those of the authors and do not necessarily imply or
reflect the opinion of the companies or institutions involved.
Contents
Foreword ....................................................................................................5
Acknowledgements .....................................................................................6
Brief Introduction ......................................................................................7
Chapter 1. Introduction of SangSangai
8
1.1 What is SangSangai? .............................................................................8
1.2 What is special about the SangSangai method? .....................................8
1.3 History of SangSangai in Nepal ............................................................9
1.4 Objectives of SangSangai ......................................................................9
1.5 Summary of the five stations ............................................................. 10
1.6 SangSangai setting ..............................................................................11
Chapter 2. Implementation of SangSangai event
12
2.1 Role and Responsibility of a SangSangai facilitator .............................12
2.2 Step-by-step guide on how to implement a SangSangai event..............13
Chapter 3. Description of SangSangai stations
18
3.1 HIV Transmission and Prevention ......................................................18
3.2 Sexual Health .....................................................................................27
3.3 Contraception and Family Planning ...................................................34
3.4 Gender ...............................................................................................43
3.5 Sexual and Reproductive Rights .........................................................50
Chapter 4. Facilitation skills 58
Chapter 5. Monitoring and supervision 68
Annexes 74
Annex 1: Material checklist ......................................................................74
Annex 2: Pictures of all materials ..............................................................76
Annex 3: Questionnaires ..........................................................................99
Foreword
Adolescents in Nepal generally do not have access to age-appropriate, gender-sensitive and
correct information on sexual and reproductive health and rights and the related services
available for them. Therefore, adolescents in Nepal are at high risk of early pregnancies as
well as of infections with HIV or other sexually transmitted infections.
A concerted effort to address the information needs of adolescents is required to create a
healthy generation that can drive the development of Nepal. The introduction of SangSangai, an interactive behaviour change communication method, into Nepal is a new stepping
stone in the joint health and education sector response to improving adolescent sexual and
reproductive health. SangSangai is in line with the recently developed National Adolescent
Sexual and Reproductive Health Communication Strategy (2011-2015) and will contribute to and complement the sexuality education provided in Nepali schools by the Ministry
of Education.
I would like to offer my sincere appreciation to the German Federal Agency for Health
Education (BZgA) who developed this method in Germany and GIZ and GFA Consulting
Group for bringing this method to Nepal. I would also like to thank National Health Education, Information and Communication Centre and all Family Health Division staff for
their technical support throughout the development of the revised version of SangSangai as
well as all the individuals from civil society and other external development partners who
made a contribution throughout the past year in various workshops and consultations.
Dr. Senendra Upreti
Director
Family Health Division
August 2012
SangSangai Facilitator’s Manual 2012
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Acknowledgements
GFA Consulting Group and GIZ would like to thank all those who have contributed to
develop this SangSangai facilitator’s manual and have helped us make it reader and userfriendly. We would like to acknowledge their inputs, advice, invaluable comments during
the process of the manual development. We would like to specially thank Family Planning
Association of Nepal (FPAN) and Nepal Red Cross Society (NRCS) for their dedicated
support, inputs and interest to take SangSangai to the adolescent communities to enable
them to lead a safe sexual and reproductive health life.
Special thanks go to the GFA team, Ms. Pushpa Lata Pandey and Ms. Jamuna Shrestha
Bhattarai for elaborating this SangSangai facilitator’s manual and to Ms. Kathrin Schmitz
and Mrs. Christine Winkelmann for their invaluable technical inputs throughout the
development process. I would like to especially mention Keshar Joshi who has over the past
few months relentlessly worked on the design of this handbook, the stations and all materials and who has given SangSangai the logo and the look that it has today – he has put our
ideas into life.
I am extremely thankful to the Family Health Division and the National Health Education, Information and Communication Centre for their guidance during the entire development process of SangSangai and their strong political interest to address the sexual and
reproductive health needs and rights of adolescents in Nepal. The commitment of the Ministry of Education to provide comprehensive sexuality education to young Nepali people is
encouraging and I hope that SangSangai will be visiting many schools and allowing many
students to profit from participating in this innovative method around Nepal.
Eva Schildbach
Team leader
GFA Consulting Group GmbH
August 2012
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Brief Introduction
The aim of this manual is to guide local coordinators and trained SangSangai facilitators to
implement SangSangai in school settings. The manual is also a valuable reference material
during the training of SangSangai facilitators. This manual can also be consulted by anyone
who wishes to learn more about SangSangai. The manual consists of five chapters:
Chapter 1: Introduction of SangSangai
This chapter provides background information on the SangSangai method and its objectives and the adolescent sexual and reproductive health (ASRH) topics it addresses.
Chapter 2: Implementation of a SangSangai event
This chapter provides step-by-step information on how to conduct a SangSangai event, the
role and responsibility of the coordinator and the SangSangai facilitators.
Chapter 3: Description of SangSangai Stations
This chapter provides descriptions of the five SangSangai stations, details on how to run
each activity and explanations of all the supporting materials needed for the station. Moreover, the chapter includes key messages and objectives for each station.
Chapter 4: Facilitation Skills
This chapter covers important guidance for facilitators when facilitating a SangSangai station including characteristics of a good facilitator, dealing with challenging situations and
participants as well as communication skills.
Chapter 5: Monitoring and Supervision
This chapter outlines the monitoring system and refers to the major monitoring, reporting
and supervision tools available to guide and steer the management and implementation of
SangSangai.
Please note:
This manual does not cover all the technical information required to successfully facilitate the five SangSangai stations. Each facilitator is responsible for acquiring adequate and updated technical information
from appropriate sources (e.g. internet, government information materials, colleagues).
Please note:
This manual gives guidance to the coordinators and facilitators of SangSangai and replaces the previous
SangSangai facilitator’s manual developed in 2008!
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1
Chapter
Introduction of SangSangai
1.1 What is SangSangai?
SangSangai is the Nepali name and version of the Join-in Circuit
(JIC). The Join-in Circuit (JIC) was first developed by the German
Federal Centre for Health Education (BZgA) in 1994 within the
German AIDS campaign ‘Don’t give AIDS a chance’ in order to
approach sensitive issues in a creative, youth friendly and participatory way. The JIC consists of a minimum of 5 physical stations that
young people visit in groups. At each station, through the interaction with their peers and a trained and skilled facilitator, they learn about a different topic
related to sexual and reproductive health and rights including HIV. GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit) initially adapted and tested this tool in Mongolia, Ethiopia, Bangladesh, El Salvador and Mozambique. It has since been implemented
successfully in more than 15 countries with the support of the German Development Cooperation via GIZ and was introduced and adapted to the Nepali context in 2007. The Nepali
name of JIC is “SangSangai” which translates into ‘let’s play together, let’s learn together’
that was chosen to reflect the interactive and mutual learning nature of this method.
1.2 What is special about the SangSangai method?
SangSangai is a special method that uses interactive, participatory activities and pictorial
materials to promote communication among adolescents about sensitive issues regarding sex,
sexual and reproductive health and rights incl. HIV with a view to changing their behaviour.
The main target group of SangSangai is adolescents aged 15 -19 years.
The concept behind SangSangai is to learn together in a group of friends and peers about the
new responsibilities that come with adulthood and to do this in an entertaining and constructive manner which stresses the positive aspects associated with protecting your own health. As
adolescence is the time where people become sexually active, SangSangai aims to show adolescents options for protecting themselves from unwanted pregnancies and STIs incl. HIV and
build up fulfilling relationships. SangSangai also aims to encourage the young peoples’ health
service seeking behaviour in view of sexual and reproductive health issues.
SangSangai is a method that reaches a large group (minimum 50, ideally 60 and maximum
70 adolescents at a time) in a very short time: 3 hours on average are required for the implementation of one SangSangai event. As SangSangai requires a large group of participants,
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schools have been selected as the ideal site for implementing it, however, if access to a large
group of out-of-school adolescents is guaranteed, the method is equally promising.
1.3 History of SangSangai in Nepal
Between 2008 and 2010, SangSangai was implemented in two districts (Dailekh and Kathmandu) by one national NGO (Youth Action Nepal) based in Kathmandu and one regional
NGO in Dailekh. The adaptation and implementation process was supported by GTZ
(now the German Development Cooperation via GIZ) in close cooperation with NCASC
(National Centre for AIDS and STD Control) as it previously had a strong focus on HIV
prevention. Between 2008 and 2010, SangSangai reached around 17.000 adolescents in the
two districts.
GFA Consulting Group is contracted since 1 November 2010 in the framework of the Health
Sector Support Programme (HSSP) of the Ministry of Health and Population (MoHP).
HSSP is a bilateral development program with financial support by the German Ministry for
Economic Cooperation and Development (BMZ) and Technical Assistance by GIZ. Within
HSSP, GFA Consulting Group is implementing the component ‘Promotion of sexual and
reproductive health and rights’ and the work plan contains a continuation of the SangSangai
implementation in Nepal. In order to ensure that SangSangai is still in line with young people’s
needs and in line with national policy and programming four years down the line, an impact
and process evaluation was commissioned in order to assess and subsequently further improve
the implementation modality, relevance and effectiveness of SangSangai. Based on the findings
of the evaluation as well as bilateral conversations with relevant government institutions from
the health and education sector, EDPs and NGOs, SangSangai was revised between December
2011 and March 2012. The major changes in comparison to the previous SangSangai are:
• National level steering by the Ministry of Health and Population and the Ministry of
Education and its relevant implementation bodies to ensure a better and more effective
use of SangSangai in schools complementing ongoing curriculum-based sex education
• Implementation through Family Planning Association of Nepal (FPAN) and Nepal Red
Cross Society (NRCS) to take the method to scale in line with their regular school-based
health and/or sex education interventions
• The five topics of the stations to address the following aspects of adolescent sexual and
reproductive health (ASRH): HIV transmission and prevention; Gender and GenderBased Violence; Sexual and Reproductive Rights; Contraception and Family Planning;
and Sexual Health.
1.4 Objectives of SangSangai
1. Enhanced utilization of health services through reinforcement of health-seeking behaviour:
• Increased use of family planning services
• Increased use of counselling and care services for STIs incl. HIV
2. Enhanced communication among peers as well as with parents, teachers and service providers
3. Increased motivation to look after and respect the sexual and reproductive health and
rights of oneself and others
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1.5 Summary of the five stations
1. HIV Transmission and Prevention
At this station, participants briefly discuss and jointly learn about the differences between
HIV and AIDS. They find out which body fluids can transmit HIV and discuss situations
in which these body fluids are exchanged as well as three important ways of preventing
HIV transmission: using a condom, using new needles and syringes when injecting drugs
and accessing treatment when being pregnant and HIV-infected. In the next activity the
participants use pictorials to discuss the risk of various behaviours in view of HIV transmission and complete this station by acting as counsellors to a fictitious friend who has a few
questions on HIV.
2. Sexual Health
At this station, participants learn in a fun way about the male and female reproductive
organs, how babies are produced and the valuable function of menstruation in the fertility process. Participants then go on to reflect and discuss the consequence of adolescent
pregnancy in Nepal in various fields of life including education, (mental/emotional) health,
social aspects and finding work. They end this station by discussing statements on sexual
health and relationships.
3. Contraception and Family Planning
At this station, participants are introduced to 6 common methods of contraception in
Nepal: oral contraceptive pills (OCP), condom, implants, injectables, IUCD, and emergency contraception. As the condom has the dual function of preventing both from
becoming pregnant and getting infected with HIV and most other sexually transmitted
infections (STIs), the condom gets special attention: first, the facilitators demonstrate the
correct use of a condom with the help of a wooden model; afterwards participants practice
themselves in same sex groups.
4. Gender
At this station, participants are introduced to the concept of gender. The difference between sex and gender is introduced by presenting several gender-related statements and
roles. In the following activity, facilitators share a definition of gender-based violence and by using pictorial cases - promote a discussion among participants about causes and consequences of gender-based violence in Nepal, particularly in view of the sexual and reproductive health of adolescent girls and boys. An important task is to think about ways how to
prevent this widespread type of violence and where to seek support when experiencing or
witnessing gender-based violence. In the third activity, participants discuss changing gender
roles and the importance of education for women, which allows them to earn money, to be
more independent and to ultimately better protect their health.
5. Sexual and Reproductive Rights
At this station, participants become aware of their key sexual and reproductive rights and
reflect on examples of these rights in their daily life. The facilitators use case studies to
discuss common situations of adolescents in which these rights are violated and to develop
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ideas on how vulnerable community members can be supported. The station ends with an
entertaining puppet play displaying again several important sexual and reproductive rights
and providing the basis for a better understanding on how these rights can entitle and
empower adolescents.
Please note:
SangSangai is primarily a method that aims to encourage adolescents to communicate about sexual and
reproductive health issues. Detailed and specific information that supports the messages given at the
stations will be available in the SangSangai booklet. This booklet will be distributed to each participant
after the event to take home, read and share with their friends.
1.6 SangSangai setting
The following picture shows the sequence in which the stations are arranged in a school
compound or school hall. Please note that each group of participants starts at a different
station, but always moves in the same direction.
SangSangai setting
Gender
Contraception
and Family
Planning
HIV
Transmission
and Prevention
Sexual and
Reproductive
Rights
Sexual Health
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2
Chapter
Implementation of SangSangai event
2.1 Role and Responsibility of a SangSangai facilitator
Facilitators need to have completed a training from a qualified SangSangai trainer before
they are allowed to facilitate SangSangai stations. Occasionally, refresher trainings for facilitators will be organized. However, it is expected and of highest importance that all facilitators keep themselves updated about technical issues covered in SangSangai as part of their
professional development.
Each station requires two facilitators, so a minimum of 10 facilitators is involved in one
SangSangai event. The team of two facilitators at each station clarifies who is facilitating
which part of the activities/discussions beforehand. It is fine if one of the facilitators takes a
lead role in conducting the activities while the other one assists (e.g. by holding and placing
cards) or if both share the activities and change roles throughout the station. It is crucial
that the two facilitators agree and rehearse in advance who does what. Both facilitators are
responsible for their station, which they will run throughout the whole SangSangai event.
The facilitators act as a well coordinated and strong team in order to optimally support the
participants and serve as role models for a constructive way of communication. During one
SangSangai event, the facilitators are welcoming 5 groups of 10 to 12 people each. In 20 or
23 minutes, depending on what has been decided by the facilitators, they guide the participants through the station, which consists of different activities and materials to promote a
discussion among participants related to the respective key messages.
Please note:
Each facilitator has a different personality with strengths and weaknesses. It is recommendable to be
aware of your own strengths when taking over the role of a SangSangai facilitator. Often it is particularly
easy for two facilitators to successfully cooperate at a station, if their strengths complement each other.
The major responsibilities of the facilitators are to:
• encourage participants to talk and share their own knowledge and to enjoy this;
• encourage participants to reflect their own behaviour and actions;
• provide participants with correct information ONLY if the group does not know the
correct answer to a question;
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• give options where to get further information and encourage participants to access
(adolescent-friendly) health services;
• give options for behaviour change: widening of choices for protective behaviour taking
into consideration the needs of adolescents.
Please note:
Facilitators are the heart of SangSangai and the success of SangSangai depends on good facilitation. A
facilitator needs to know and practice facilitation skills such as creating a good learning environment,
asking the right questions and practice probing and bouncing back of questions during facilitation. A good
facilitator should avoid lecturing! Please regularly practice self-reflection based on the recommended
SangSangai facilitation methods (see chapter 4).
2.2 Step-by-step guide on how to implement a SangSangai
event
2.2.1. Steps to take: Preparations by the coordinator:
Besides the 10 facilitators who stand and work at the stations, one coordinator accompanies the team. The coordinator has the important task to contact the focal person of the
school where the SangSangai event will take place beforehand. The coordinator:
• shares basic information, e.g. that the ideal number of participants is around 60 for
each SangSangai event (- if there are more adolescents of appropriate age, two SangSangai events can be organized consecutively at the same school, which also enhances the
chance, that one of the five participating groups can be composed of teachers, medical
staff and representatives of support groups, please see below),
• collects information from the focal person about health facilities (e.g. opening hours,
services in the field of sexual and reproductive health, names of people in charge, how
to get there), local support groups (e.g. on HIV, violence against women, etc.), options
where to get condoms,
• asks the focal person to invite the teachers to come to the SangSangai event, there might
also be an opportunity for them to participate in SangSangai as an “adults only” group,
if there is space for another group/enough time – adolescents always have the priority of
participation in SangSangai,
• ask the focal person to invite staff from local health centres, Female Community Health
Volunteers (FCHV), representatives of support groups to come to the SangSangai event;
in case there is an “adults only” group participating in SangSangai, they are welcome to
join this group.
SangSangai has the important aim to encourage adolescents to utilize sexual and reproductive health services. Therefore, it is important, that before each SangSangai event all facilitators learn from the coordinator, which services are available in the specific local context.
This way, the facilitators are able to suggest specific services/people to the participants. An
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additional way of increasing the chance that adolescents actually use services is to invite
staff from local health centres, FCHV and representatives of local support groups to the
event. The SangSangai event can establish closer connections between adolescents/teachers
and health service and support providers which can serve as a bridge.
During the SangSangai event, the coordinator is in charge of logistics, time keeping and
the overall organization of the whole event. He/she closely coordinates with the focal
person of the school. At the beginning it is the coordinator’s responsibility to welcome the
participants and to introduce them to SangSangai and the facilitators. While the event is
running, the coordinator circulates through the stations to offer assistance and support to
the facilitators where needed and to indicate the time. This table provides an overview of a
typical SangSangai event and the time required:
SangSangai event
Activity
Time required
Setting up the stations
10 min
Welcoming the participants
5 min
Getting participants into groups
5 min
Administering pre-test
10 min
SangSangai implementation
100 min (20 min per station, this time
can also be extended to 23 minutes
per station in order to allow for more
probing and discussion)
Movement of participants from one station to the next
2 min
Administering Post-test
10 min
Getting the participants in one group
5 min
Collection of feedback if any and thanking for participation
8 min
SangSangai booklet distribution
5 min
Total
160 - 175 (approx 2.5 hrs)
Note: In situations where facilitation and participation is tiresome because of weather conditions (i.e. hot weather) it is recommendable to include a break of 15 minutes between the 3rd and 4th activity and to provide some refreshment/snacks to the participants.
2.2.2 Steps to take: Before the participants arrive:
• The coordinator provides a briefing to the key focal persons at the school including
teachers and administrative and support school personnel.
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• The facilitators prepare the venue (e.g. clearing garbage) and identify a suitable location
for each station.
• The facilitators set up the SangSangai stations in the right sequence and ensure that all
relevant materials to conduct the activities are available. In addition, they have a sufficient number of (pre and post-test) questionnaires on hand as well as drinking water
(use the checklist in Annex 1).
• The coordinator and the facilitators agree on the time indications given by the time keeper.
• The facilitators get mentally prepared and remember the key messages of their station.
• The coordinator ensures that sufficient SangSangai booklets and refreshments (water &
snacks) are on hand.
2.2.3 Steps to take: When the participants arrive:
Step 1: The coordinator welcomes the participants
Suggestions for the content of a welcome speech to the whole group:
Welcome
Brief introduction of the organization conducting the SangSangai event
Introduction of SangSangai:
• Purpose is to learn about sexual and reproductive health & rights in a fun & entertaining way
• 5 Stations with different topics
• Games and other activities at each station
• Confidentiality
• Time keeping
• Movement of groups from station to station simultaneously
Announce that at the end of the event, each participant will receive a SangSangai booklet.
Step 2: Getting participants into groups
• The school should have been informed about the ideal number of participants (60
students) and ideally there should be an equal number of boys and girls (not always possible).
• The coordinator or the accompanying teacher splits the group into boys and girls and
counts them in order to ensure that an equal number of girls participate in each of the
5 groups, e.g. if there is a total of 30 girls, then 6 girls are allocated to each group. The
same method ensures that an equal number of boys participate in each of the 5 groups.
• The coordinator sends each of the 5 groups to a different SangSangai station.
Step 3: Receiving the participants at their first station
The two facilitators at each station receive their first group. It may take some time until all
participants are at their first station. The facilitators welcome the participants in a friendly
way, briefly explain the purpose of the pre-test questionnaire and distribute questionnaires
and pens to their group. Afterward, the facilitators share the basic rules of the game:
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• Respect your group members
• Give everyone time to speak and listen
• Respect the confidentiality of what your friends or peers say
• Questions are very welcome
• Give everyone the chance to contribute, even if you know the answer
Step 4: Running of SangSangai Stations
• At the starting sign of the time keeper or even earlier the facilitators welcome the group
& introduce themselves and the topic of the station.
• The facilitators guide the participants through the station in line with the sequence of
activities outlined in Chapter 3.
• At the sign of the time keeper indicating that the time is coming to an end, the facilitators wrap up the last activity, wish something positive on the participants (see the suggestions at the end of each station in Chapter 3) and thank them for their participation.
• At the sign of the time keeper indicating the end of the 20 minutes (or the 23 minutes
if this has previously been decided by the facilitators), the facilitators say goodbye and
send the participants to the next station (they need to be aware of where the next stations is located to avoid loss of time due to confusion).
• The facilitators quickly tidy up the station before the new group arrives so that they
have all materials in place and ready for the next group.
Things to bear in mind when facilitating a station:
Encourage a lively discussion and ensure a safe and fun learning environment
Guide the participants to find the answers themselves by asking and bouncing back questions and
probing
Promote critical reflections on attitudes and behaviour among participants
Enlarge the options for action in specific situations by brainstorming & suggesting healthy alternative behaviours
Build on the participants’ daily experiences and adapt the level of the station to the level of the
target group
Give only correct information and only when the group does not know the answer
Manage the group – you are in charge as a facilitator
Speak openly & confidently about sexuality, you can also use humour to break the ice sometimes
Serve as a role model
Cooperate with your co-facilitator – be a strong team: e.g. as one facilitator facilitates the activity
the other facilitator cleans up or prepares for the next activity/group
Remember the key messages of the station
Listen to the time keeper and complete the station on time, not later, not earlier
Always complete the station with a positive wish on the participants
Step 5: What to do once all groups have completed all 5 stations
• The facilitators hand out the post-test questionnaire to the group at their station and ask
participants to complete them.
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• The facilitators then ask the groups to join together and form one big group.
• The coordinator gets a brief feedback from the participants (entertaining).
• SangSangai booklets are distributed and participants are invited to read them carefully
in their free time and to share it also with brothers, sisters and friends.
• The coordinator encourages participants to live a happy and self-determined life.
• The event ends with a round of thanks to the principal, the teachers and others who
have made it possible to conduct the SangSangai event.
Step 6: After the participants have left:
• The facilitators quickly clean their station materials, put them in order and pack them
quickly to avoid theft and to ensure that they are protected from sun/rain and safely
stored.
• The coordinator completes the ‘SangSangai event report’ (Annex 3.2).
• The facilitators hand over the pre- and post-test questionnaires to the coordinator, he/
she makes sure that they are safely stored and protected from rain and taken back to the
office.
• The coordinator asks all facilitators to come together for a short review meeting to share
the facilitators’ experiences.
• The coordinator and facilitators clean the school ground after the completion of SangSangai to set a good example in cleanliness and care for the environment.
Please note:
Especially the condoms but also some of the other materials such as the contraceptives are interesting
to young people so make sure that they don’t get stolen. Of course, if a participant asks you for some
condoms you can provide them to him/her.
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3
Chapter
Description of SangSangai stations
This part of the facilitator’s manual describes each of the 5 stations step by step. It lists
objectives and key messages of each station, describes the activities and materials used and
provides guidance for time management and how to close the session. It is of great importance to always prepare each station thoroughly and have all materials ready.
As we directly address facilitators in this chapter of the manual, we will in the following address the facilitators by using “you” instead of the abstract “the facilitator”.
3.1 HIV Transmission and Prevention
Objectives of the station:
After this station, SangSangai participants:
• know that HIV is a virus that causes AIDS.
• can distinguish infectious and non-infectious body fluids.
• know how the HI-virus can enter the body,
• and thus are able to differentiate risky and non-risky behaviour.
• know how to protect themselves and others from infection with HIV and most other STIs.
Key Messages:
• HIV is a virus, this virus causes AIDS and this disease cannot be cured.
• HIV infections can be treated and persons living with HIV can live a quality life
with medication.
• HIV can be transmitted via 4 body fluids.
• Visit a health facility if you have been at risk of HIV infection.
• Visit a health facility if you are HIV-infected and pregnant.
• To protect yourself from HIV infection, you can:
1) Use condoms during sexual intercourse, and
2) Use new needles and syringes if injecting drugs.
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Welcome to the Station!
Welcome the participants at the station, introduce yourselves with your names and say: “At
this station, you will learn about HIV and AIDS, how it is transmitted and how you can
protect yourself.”
Activity 1: Introduction to HIV and AIDS
1 minute
Messages given during this activity:
• HIV is a virus, this virus causes AIDS and this disease cannot be cured.
Recommended
Position
• HIV infections can be treated.
Materials:
No materials required.
Preparation of activity:
No preparation is required for this activity.
Step-by-step guide:
Ask the participants: “Who can tell me what HIV is and what AIDS is?” Use probing,
correct misinformation, confirm the correct answers. The following correct information
should be given throughout this exercise:
HIV is the virus that causes AIDS. This virus is passed from one person to another through sexual contact
and from blood-to-blood. In addition, infected pregnant women can pass HIV to their baby.
Most of the people infected with HIV will develop AIDS as a result of their HIV infection after several
years. AIDS is a condition that describes an advanced state of HIV infection, when the immune system is
seriously weakened and the body is vulnerable to all sorts of diseases.
There is no cure for HIV. However, the life of an HIV-infected person can be prolonged with medication
called ART as long as the medication works. Whenever you think you have been at risk of HIV infection,
you should visit a health facility for advice.
Activity 2: Body fluids and HIV prevention
• There are only four body fluids which can transmit HIV from one person
to another person:
6 minutes
Recommended
Position
1)Blood
2)Semen
3) Vaginal fluid
4) Breast milk
| 19
• HIV is NOT transmitted through urine, sweat or saliva.
• To protect yourself from HIV infection, you can:
1) Use condoms during sexual intercourse, and
2) Use clean needles and syringes if injecting drugs
• Visit a health facility if you are HIV-infected and pregnant.
Materials:
• Seven drops with body fluids
• 2 circles: one saying INFECTIOUS, one saying NON-INFECTIOUS
• 6 large puzzle pieces:
Puzzle 1
Puzzle piece with pictorial on sex
Text: Use a condom correctly during sexual
intercourse
Puzzle 2
Puzzle piece with pictorial on injecting drug use
Text: Use clean needles and syringes if you are
injecting drugs;
Puzzle 3
Puzzle piece with pictorial on
mother-to-child transmission
Text: Visit a health facility if you are HIV-infected
and pregnant
Lay out the seven drops on the ground and the two circles saying INFECTIOUS and
NON-INFECTIOUS.
Step-by-step guide:
1) Ask the participants: “What might these drops symbolize?”
Answer: body fluids. Explain that body fluids are liquids in our body that can come
out of our body.
2) Ask the participants: “If a person is HIV infected, which of these body fluids cannot
transmit the HIV virus when leaving the body? If you know which one, then please
take the drop and put it in the circle saying NOT INFECTIOUS. And those fluids
that can transmit HIV, please put them in the circle saying INFECTIOUS.”
After the group has put the drops in the two circles, ask the participants: “Would
anyone like to change anything?” If yes, let the participant shift the respective drop to
the other circle. If there is still a wrong answer, you correct by shifting the drop(s) in the
right circle. Stress that there are only four body fluids which can transmit HIV from
one person to another person if they are exchanged between two persons: blood,
semen, vaginal fluid and breast milk.
20 |
3) Ask the participants: “Do you know, in which situations people exchange these four
body fluids?”
For every correct answer given by the participants, put down the respective puzzle piece:
• Puzzle piece with pictorial on sex
• Puzzle piece with pictorial on injecting drug use
• Puzzle piece with pictorial on mother-to-child transmission
4) Once participants have mentioned all three situations and the three puzzle pieces have
been put on the floor, ask “How in these situations can you prevent the transmission
of HIV?”
For every correct answer, put down the matching puzzle piece:
• Use a condom correctly during sexual intercourse;
• Use new needles and syringes if you are injecting drugs;
• Visit a health facility if you are HIV-infected and pregnant
Please note:
Only put the puzzle pieces down, if the participants have given the right answer. Use probing! Only if
participants do not give the right answer, you put down the puzzle piece and explain to them the meaning.
Please note:
Most participants might not have heard about mother-to-child transmission and options for preventing
it, so you can probe: “Do you know what a pregnant mother, who is HIV-infected, can do to prevent that the
virus is transmitted to her baby?”
Explain that a pregnant woman living with HIV can infect her baby during pregnancy, during birth and
during breastfeeding. There are health facilities that offer clinical services (PMTCT) at district hospitals
that can provide medication which will help to prevent that the virus is transmitted to her baby.
5) When all three puzzles have been completed, ask the group:
“Do you know where to get condoms?”
Stress correct answers, add information about where to get condoms if important ideas
have not been mentioned. It is particularly helpful if you have knowledge about specific
local options where to get condoms, e.g. from your conversations during the preparation of the SangSangai event.
“Is there a vaccination against HIV?”
Correct answer: No.
“Can you use oral contraceptive pills to protect yourself from HIV infection?”
Correct answer: No.
| 21
Activity 3: Risky and non-risky behaviour
• There are several risky behaviours for HIV transmission.
6 minutes
Recommended
Position
• HIV transmission can be prevented if we avoid risky behaviour.
Materials:
• 11 cards with behaviours (please see detailed information on risk related to each behaviour below)
• 3 smileys (safe/no risk; low risk; high risk)
Put the 3 smileys on the floor and hold the 11 cards with behaviours in your hands.
Step-by-step guide:
1) Explain that now you will look at different kinds of behaviours and that the participants have the task to decide whether these behaviours can transmit HIV or not.
2) Explain the three smileys on the floor:
Happy Smiley: There is no risk of HIV transmission, this behaviour is safe.
Neutral Smiley: Low risk of HIV transmission
Unhappy Smiley: High risk of HIV transmission
3) Distribute all 11 cards on risk behaviours among the participants and ask them to put
their cards under the respective smiley. Encourage them to discuss with others where
to put the card(s).
4) When all cards are placed under the smileys, ask the participants to stand in a half
circle, so that everybody can see the cards. If they have been put on top of each other or
are not clearly allocated to one of the smileys, quickly arrange the cards so that they are
all visible and in neat lines.
5) Ask the participants to have a look at the cards under NO RISK.
Quickly – as these are generally correct – go through the cards that are correct by stressing that these behaviours are safe (without discussion) and tell them they did a good
job. If there is an incorrect card, ask the participants, whether they agree. After discussion and agreement place card in the correct column.
6) Ask the participants to have a look at the cards under HIGH RISK.
Start with the correct ones: ASK the group: “Why is this high risk behaviour?”
(referring if possible to the body fluids if there is confusion). When you have discussed
22 |
all correct cards, pick up the incorrect cards and ask “Is this high risk behaviour?”
After discussion (by again referring to the body fluids) and correction, put it in the correct column.
7) Ask the participants to have a look at the cards under LOW RISK. Start with the correct ones:
ASK the group: “Why is this low risk behaviour?”
When you have discussed the correct cards, pick up the incorrect cards and ask “Is this
low risk behaviour?” After discussion, put it in the correct column.
Please note:
Probe as much as possible for correct answers and ensure that the group or you correct wrong information. Make sure that at the end of this activity ALL cards are in the right risk column and that the right
reasons for doing so have been mentioned (refer to infectious body fluids).
8) Finish the activity by asking the group: “Can you remind me what were the three
ways of preventing HIV transmission that we have just discussed before?”
| 23
High-risk behaviours
1
Vaginal sex without
condom
Vaginal sex without condom carries a high risk of infection, as semen
or in some cases blood rubs against the vagina of the woman and
vaginal fluids are rubbed into the penis.
2
Anal sex without condom
Anal sex without a condom carries a high risk of infection, as semen
or blood rub against the moist skin in the anus (rectum). Anal sex
can lead to bruises and wounds in the rectum, making it even more
likely to pass on the HI-virus. Also, blood from the rectum can be
rubbed into the penis.
3
Sharing of syringes/
needles among injecting drug users
Sharing of syringes or needles when injecting drugs is very risky,
as the syringes and needles can contain blood from an HIV-infected
person. Syringes or needles can easily transmit HIV (as well as
Hepatitis B+C). If you inject drugs, always use a new needle and new
syringe and never share needles or syringes with others.
4
Mother-to-child transmission (MTCT)
The transmission of HIV from an HIV-infected mother to her baby is
risk behaviour if she does not seek medical care at a PMTCT centre.
If she does not seek medical care, there is a low risk that the unborn
baby gets infected with HIV during pregnancy or breastfeeding and
a high risk that it gets infected during labour.
The risk of transmitting the virus to the baby is very low, if the
pregnant woman living with HIV visits a health facility to receive
advice and the right medication (ART) during pregnancy, giving birth
and breastfeeding.
Low-risk behaviours
5
Oral sex if sperm
or blood enters the
mouth
If sperm or menstrual blood enters the mouth of the man or woman,
the virus can be transmitted. This is more risky, when there are
wounds or small cuts in the mouth.
No-risk behaviours
6
Caring for an AIDS
patient
While caring for a sick person with AIDS, this includes feeding, washing, helping to go to the toilet, etc. one cannot get infected with HIV,
because there is no exchange of infectious body fluids.
7
Mosquito bites
The virus does not survive in a mosquito’s body. HIV cannot be transmitted through a mosquito bite.
8
Vaginal, anal or oral
sex with condom
The correct use of condom prevents HIV infection, because no infectious body fluids are exchanged.
9
Eating, studying or
playing together
Playing, studying or eating together or from the same plate, using
the same knife and fork does not transmit HIV.
10
Sharing clothes or
sleeping in one bed
HIV cannot be transmitted through sharing clothes incl. underwear
or sleeping in the same bed.
11
Deep kissing
Saliva is not an infectious fluid, thus there is no risk of HIV infection.
24 |
Activity 4: “What would you recommend, if a friend told
you ...?”
7 minutes
Recommended
Position
• To protect yourself from HIV infection, you can: use condoms during
sexual intercourse.
• Visit a health facility if you have been at risk of HIV infection.
• HIV infections can be treated and persons living with HIV can live a quality life with
medication.
Materials:
• 3 text cards with description of situation
Hold the 3 text cards in your hand in a way which does not allow the participants to read
them.
Step-by-step guide:
1) Ask the participants to imagine that the co-facilitator is their best friend. Ask for a
volunteer to choose one of the cards in your hand.
Your co-facilitator plays the best friends and says: “Imagine, I am a good friend of
yours and I tell you that ... (finish the sentence with the example on the card). What
would you recommend me to do?”
Ask who would like to give advice. If no one responds, probe by asking one participant. After the first participant has given a recommendation, let the group add ideas
and make sure that the messages below come across.
Please note:
The co-facilitator acting as the friend asking for advice can also react to the recommendations by directly
addressing the participants: “Do you really think so?” or “What will the VCT staff do with my test results?”
| 25
Card 1
Imagine, I am good friend of
yours and I tell you that …
Message
“A good friend of mine recently
found out that he/she is HIVinfected. We spend a lot of time
together; we study, exercise
and eat together. Sometimes
we even swap clothes. Do I
need to worry now that I might
get infected, too? Should I stop
seeing him/her?”
No, HIV cannot be transmitted through these activities.
By studying, exercising and eating together, swapping
clothes and other activities in which none of the four
infectious body fluids is exchanged you cannot get
infected with HIV.
Always probe: “Can HIV be
transmitted in these everyday
interactions?”
Card 2
“I got to know a handsome
boy/girl, who looks absolutely
healthy. If we have sex, do I
have to worry about HIV infection?”
Always probe: “Can a healthylooking person be HIV-infected?”
Card 3
“I fear I might have been infected with HIV, what can I do
to find out?”
Probe: “I am worried that everybody will know that I did a
test….” (inform about confidentiality of test and test result)
Probe: “Why should I want to
find out whether I am HIVpositive?”
(To get medication, to protect
others)
Yes! An HIV-infected person can look perfectly healthy.
Also, many other STIs do not have visible symptoms.
Therefore, never think that you don’t need to use a condom to protect yourself from an infection with HIV or
other STIs, because the person you would like to have
sex with looks healthy! And a condom protects both of
you not only from HIV infection but also from pregnancy!
It is a good idea to go to the health facility or, if available, a VCT centre to tell a health worker what has
happened. The health worker will advise you whether
to do an HIV blood test or not.
All test results are kept confidential and the health
worker will not share with others that you have come
for a test or the test results.
If you should really have been infected with HIV, they
can give you advice and later on medication (ARV) if you
need them. While there is no cure for HIV, many persons
living with HIV who take the ARV medication can live a
quality life. Health services will also help you to prevent
a transmission from mother to child (PMTCT) if you are
pregnant. There are support networks that help you in
case you are HIV-infected.
Please note:
If you prefer, you can use other words to ask the questions and/or decide to put all questions into one
case study. Please ensure that you ask clear questions and that you do not reinforce wrong information!
Closing
Thank the participants for sharing their knowledge and participation and encourage them
to protect themselves from HIV infection throughout their life!
26 |
3.2Sexual Health
• know about fertility and sexual reproduction.
• know the consequences of adolescent pregnancy.
• are aware of aspects of sexual health.
WHO Definition:
Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a
positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having
pleasurable and safe sexual experiences, free of coercion, discrimination and violence.
Key Messages:
• Becoming pregnant and a parent during adolescence has life-changing consequences and carries medical risks for the girl and child.
• Every girl/woman has the right to determine if, when and how often to become
pregnant.
• Whenever a man and a woman have vaginal intercourse without using contraceptives there is the chance to become pregnant.
• Sexual relationships should be based on mutual respect and communication and
should never be based on sexual coercion.
Welcome the participants at the station, introduce yourselves with your name and inform
the participants that at this station, they will learn about fertility, sexual health and the
consequences of adolescent pregnancy.
Activity 1: Puberty and Fertility
8 minutes
• During puberty girls and boys become fertile and can reproduce.
Recommended
Position
• The female body can conceive and carry a child, a girl can become pregnant.
• Whenever a man and a woman have vaginal intercourse without using contraceptives
there is the chance to become pregnant.
• Menstruation is a natural cleansing process of the female body.
| 27
Materials:
• 1 large picture of female reproductive organ showing uterus, vagina, fallopian tubes and
ovaries with eggs
• 1 large picture of a male reproductive organ (penis and testicles)
• A picture of an egg
• A picture of a sperm
• A picture of egg and sperm united
• A picture of menstrual blood with egg waving hand.
• Seven text cards with questions for facilitators
Put the picture of the female reproductive organs (ovaries, fallopian tubes, uterus, vagina),
the picture of the male organ (penis and testicles) on the floor. Hold the cards and the following 4 pictures in your hand: egg, sperm, egg and sperm united, menstrual blood with
egg waving hand.
Step-by-step guide:
1) Tell the participants that during this activity they will learn about their reproductive
organs and how babies are made as our bodies are becoming ready for this during
puberty.
2) Give the egg and sperm pictures to two participants (one male, one female).
3) Ask the participants the following questions in the given order and use probing as much
as possible:
“What do you see on the floor? Do you know how these organs are called?”
If not, briefly explain to them the names, do not use more than 1 minute.
“What is the function of the ovaries?”
Answer: Each month one egg ripens, either in the right or in the left ovary. From there
the egg travels through the fallopian tubes towards the uterus.
Ask the participant holding the egg picture to move the egg along one of the fallopian
tubes. “Is an egg enough to start a pregnancy?”
Answer: No, a woman becomes pregnant if the egg joins with a sperm in the fallopian
tube.
“When and how does the sperm enter the female body?”
Answer: Through the vagina while having sex. The vagina is the canal between the
uterus and the external genital organs.
Ask a participant to take the penis picture and put it on the vagina. You may also
decide to do this yourself. Next, ask the participant holding the sperm picture to show
28 |
the meeting of the sperm coming out of the testicles and travelling along the penis
into the uterus and into one of the fallopian tubes. At the end of this, the sperm lies
on the egg.
You now replace the two cards with the one showing the egg and sperm united.
“If the egg has been fertilized by a sperm, what is the task of the uterus?”
Answer: A fertilized egg can settle in the lining of the uterus and it will grow there until
delivery. The growing baby receives everything it needs during 9 months, the uterus is
like a perfect luxury hotel, where the baby can stay until it is born.
The uterus is normally the size of a small mango. During pregnancy, the uterus grows
steadily in order to accommodate the growing baby.
“What happens if the egg is not fertilized by a sperm?” (put card with menstruation
blood on the uterus and move it downwards through the vagina)
Answer: If the egg is not fertilized, it dies. The soft lining of blood vessels in the uterus,
where the fertilized egg could have settled, is not needed during that month. Therefore,
the lining breaks down and passes out of the body through the vagina. What you see
when you menstruate is therefore the lining of the uterus. It is not a sign that you have
been injured.
“Is menstruation something unclean?” (please ask participants to raise their hands
for yes)
Answer: Although in Nepal menstruation might be seen as something impure in parts
of the society, menstruation is actually a natural cleansing process. Without menstruation a woman could not carry a baby, so there wouldn’t be any children!
Activity 2: Consequences of Adolescent Pregnancy
8 minutes
• Becoming pregnant and a parent during adolescence has life-changing
consequences and carries medical risks for the girl and child.
Recommended
Position
• Every girl/woman has the right to decide if, when and how often to become pregnant.
Materials:
• 2 pictures: an adolescent pregnant girl and an adolescent girl with a school uniform and
bag
• 5 text cards with 5 topics: “Education”; “Health”; “Mental/Emotional Health”; “Social/
Family”; “Finding work”
Put the two pictures of an adolescent pregnant girl and an adolescent girl with a school
uniform on the floor.
| 29
Step-by-step guide:
1) Ask the participants what they see and, after some ideas have been mentioned, tell
them that you will now talk about adolescent pregnancy.
Inform the participants: “Adolescent pregnancy means that the pregnant girl is
less than 19 years old. Adolescent pregnancy can change the life of an adolescent
mother or father in many different ways, e.g. in view of (put down the cards on
the floor): “education”, “health”, “mental/emotional health”, “finding work” and
“social/family”.
Please note:
If the participants ask you, whether the pregnant girl is married or not, just answer, that for most of the
consequences, this does not make a difference.
2) You now move from one of the five categories to the next asking the participants to
think of one or more changes for a teenage mother or father in view of the respective field of life.
Ask open questions such as: “How might the pregnancy and motherhood influence
the education of the girl?” Or “Which consequences might the pregnancy have for
the girl in view of …?”
Continue with probing, e.g. when talking about health you may ask “so when you picture a girl or a young woman and she is much smaller than an older woman – what
might that mean in terms of giving birth?”
Field
Potential changes in life
Education
• In most cases, girls who become pregnant have to leave school before reaching SLC.
• It is more difficult to focus on school, vocational trainings or studies if you are pregnant
or responsible for a child.
Health
• An adolescent pregnancy means health risks for the mother:
- Medical complications during birth as the body is not ready for pregnancy and childbirth (e.g. prolonged obstructed labour, obstetric fistula)
- Psychological stress: Adolescent pregnancy is associated with a higher risk of suicide
and violence (especially if unmarried).
- Choosing unsafe abortions (especially an issue if unmarried) is medically very risky
(e.g. unsafe abortions can cause infertility) and life-threatening, but of course you
can access a safe abortion service.
• Babies of adolescents have higher rates of stillbirth or death in first weeks and are
generally weaker.
30 |
Mental/
Emotional
Health
• It can be a big burden to be responsible for a child while being young.
• A young unmarried girl might be forced to marry the father of the child and move to
the house of the father’s parents.
• Young unmarried pregnant girls and mothers often have to face social stigma (even
though this is not acceptable and a violation of human rights).
Social
Aspects/
Family
• Adolescent mothers often lack knowledge, education, experience, income and power in
comparison to older mothers.
• The young mother might have to move to the house of the father’s parents and/or to
marry the father of the child.
• Becoming a mother might give you a higher status in society (only if you are married)
– so there might be a positive aspect, too (social acceptance).
Finding
work
• If a girl is forced to drop out of school or vocational training in order to look after
the child, she is less likely to find a job in which she earns enough money to sustain
herself, the child and the family, which might lead to financial dependence on her
husband and/or poverty.
3) Finalize the activity by summarizing, that there are a lot of good reasons for a girl to
decide not to become pregnant during her teenage years and to convince her husband/parents in law to delay birth of her first baby. Every girl/woman has the right
to decide if and when to become pregnant.
4) Wrap up this exercise by asking: “If a girl/woman does not want to become pregnant,
what can she and her boyfriend or husband do to prevent a pregnancy?”
There are different ways to prevent pregnancy (add the options not mentioned by participants):
• The boy and the girl can use a contraceptive when having sexual intercourse.
• The boy and the girl can abstain from sexual intercourse or masturbate.
Activity 3: Sexual desires and relationships
• Sexual desires are part of our personality.
4 minutes
Recommended
Position
• Say NO to sex if you don’t feel like it.
• Masturbation is not harmful.
• Sexual relationships should be based on mutual respect and communication and should
never be based on sexual coercion.
| 31
Materials:
• Board with “True”
• Board with “False”
• 3 text cards with statements for facilitators
Put the two boards saying ‘true’ and ‘false’ on the floor with space in between and facing
the participants. Hold the text cards in your hand.
Step-by-step guide:
1) During this activity, participants decide whether statements about sexual behaviour and
sexuality are true or false. Misconceptions will be corrected during the discussion. Tell
students that you will be discussing common myths about sexual behaviour and
that you will be separating myths from the facts.
2) Explain to the participants: “I will read out a statement. Please quickly decide
whether you agree or disagree with this statement by standing next to the ‘True’ or
the ‘False’ sign put on the floor.”
Once they have made a decision ask the group that has chosen the right answer to
explain why they have chosen that answer. Or ask the other group first. Motivate the
participants to give reasons for their opinion and discuss among each other. Use probing
as much as possible!
1) Statement: “Boys and men are always in the mood to have sex, but girls are not.”
Answer: No, boys are not always in the mood to have sex!
Probe for the following answers: Sexual desire is normal for boys and girls and a healthy
part of our personality. However, it depends on the feelings for the partner and the
personal mood at the specific moment whether a boy or girl is in the mood to have
sex. Girls are often a bit shy or worried about unintended pregnancies or their
reputation. It also might take more time for girls to be sexually aroused.
If you don’t want to have sex, clearly share this with your partner.
Sex which is pleasurable for both partners is often an important component of a
happy relationship!
2) Statement: “Masturbation is harmful.”
Answer: No.
If the participants are not familiar with the meaning of masturbation, give the following
explanation: “Masturbation is the erotic stimulation of one’s own genitals for pleasure,
e.g. by touching or rubbing with the own hand or toys. It is the self-stimulation of the
sex organs, most often to the point of orgasm.”
32 |
Then always probe for the following answers:
Masturbation, even if done regularly, is not harmful, it is safe and a good way to
learn about your own body and to experience sexual pleasure.
If you masturbate, always ensure that your hand or toy is clean.
Some people do it to experience sexual pleasure when they do not want to have sex
with another person, others do it also while having a girlfriend/boyfriend/husband
or wife.
It is a personal choice, some boys and girls masturbate, others do not and do not
like the idea of it.
Both men and women can fulfill their sexual desire even without involving physically with a sexual partner, they can masturbate.
3) Statement: “Sex is the only way to show each other that you love and care for
each other.”
Answer: No.
Probe for following answers: Other ways to show that you love and care for the other
person are kissing, hugging, spending time together, talking about your ideas,
dreams, supporting each other when having problems, giving each other presents etc.
3) Wrap up by saying that feelings of closeness and mutual trust and support make
relationships strong and lasting. It is important, that your partner is someone you
can talk to openly, with whom you can discuss and who respects you.
Closing
Thank the participants for sharing their opinions and wish them a healthy and safe life
where they learn to enjoy their sexuality in a healthy way.
| 33
3.3Contraception and Family Planning
• know about safe and free contraceptives (including emergency contraception) available
in Nepal.
• are informed about services and motivated to visit a health centre for contraceptives or
family planning advice, before they have sex.
• are sensitized that preventing an unintended pregnancy is a joint responsibility of both
partners and not only of the girl.
• know that the condom has a dual function: it prevents both from becoming pregnant
and getting infected with HIV and most other STIs.
• know how to use a condom.
Key Messages:
• Every girl/woman has the right to determine when, how often and if at all she
would like to become pregnant.
• Adolescents have the right to information on and to select the contraceptives of
their choice!
• Health service providers and FCHV should equip you with detailed information
and contraceptives.
• There are several safe and free contraceptives available in Nepal to prevent or space
pregnancies. Contraceptives do not affect women’s childbearing capacity. Fertility
returns when a woman stops taking contraceptives.
• The condom is special: it prevents both from becoming pregnant and getting infected with HIV and most other STIs.
Welcome to the station!
the participants that at this station, they will learn about contraceptives available in Nepal.
Activity 1: Options for contraception
• Adolescents have the right to access health facilities including family planning services. They have the right to information on contraceptives and the
right to obtain them free of charge and use them.
10 minutes
Recommended
Position
• There are several safe and free contraceptives available in Nepal to prevent or space
pregnancies. All available contraceptives - condoms, oral contraceptive pills (OCP),
injectables, IUCDs, implants and emergency contraceptive pills (ECP) - are safe for use
by adolescents.
34 |
• Contraceptives introduced here do not affect women’s childbearing capacity. Fertility
returns when a woman stops taking contraceptives.
• The condom has a dual function: it prevents both from becoming pregnant and getting
infected with HIV and most other STIs.
• Talk to your partner about contraception – choosing and using contraception is a joint
responsibility.
• ECP is an emergency measure to prevent pregnancy.
Materials:
• A bag containing all 6 contraceptives packed in plastic zip bags
• 1 extra plastic zip bag with the condom for additional participants
• 7 printed plastic cards with the information shown below (2 cards on the condom, 5
cards on the other contraceptives)
• 6 Statement cards: Questions and Answers
One facilitator holds the family planning devices, the other the matching cards in his/her
hand. At the arrival of each new group, do a quick head count to find out how many contraceptive devices you will distribute. Here is an overview of which contraceptives you use
depending on the number of participants:
Number of
participants
Distributed contraceptives
8
OCP/pill, condom, injectable, implant: participants
ECP and IUCD: facilitator
9
OCP/pill, condom, injectable, implant: participants
IUCD: participants + one facilitator
ECP: facilitator
10
OCP/pill, condom, injectable, implant, IUCD: participants
ECP: facilitator
11
OCP/pill, condom, injectable, implant, IUCD
ECP: participants + one facilitator
12
OCP/pill, condom, injectable, implant, IUCD, ECP: participants
13
OCP/pill, condom, injectable, implant, IUCD, ECP: participants
Second condom: participant + one facilitator
14
OCP/pill, condom (2x), injectable, implant, IUCD, ECP: participants
| 35
Step-by-step guide:
1) Ask the participants: “Do you have the right to use contraceptives?”
Answer: Yes, in Nepal, all adolescents have the right to get information on and to
select the contraceptives of their choice and to use them. Every girl/woman has the
right to determine when, how often and if at all she would like to become pregnant.
2) Explain the activity to the participants: “We will give different contraceptives to you
now as well as cards with information about these contraceptives. It is your task to
find your partner, e.g. if you have the oral contraceptive pills, it is your task to find
the person with the information about oral contraceptive pills!”
3) Distribute the contraceptives to girls, if possible, and the cards to boys, if possible. Do
not mention this, if the sex proportion is not the same, it is no problem if you give
contraceptives to boys or cards to girls. There are 6 contraceptives packed in zip bags (if
there are more or less than 12 participants, please refer to table above).
Invite participants to find their partner (e.g. the girl with the IUCD the boy with the
flash card on IUCD) by moving around and talking to each other. When everybody has
found his/her partner, please ask them to “Jointly read the information on your card!”
Please note:
If participants want to touch the contraceptives they can open the zip bag and afterwards put the contraceptive back into the bag.
3) After all “couples” have finished reading tell them:
“Now I will ask one couple after the other to shortly
• show the others your contraceptive by raising it up and stating its name,
• tell the others how it is used (e.g. taken orally on a daily basis, implant by health
worker in the arm)
• and give the biggest advantage of “your” contraceptive, according to your opinion. Just imagine you are doing a short TV advertisement spot for “your” contraceptive!”
Ensure that all information given is correct.
Please note:
Avoid that participants read out the contents on the card, rather invite them to use their own words.
4) Instruct the participants to stay with their respective partner and to stand around you
in a circle. Ask them to listen to the statements you will read to them. If the statement
applies to their contraceptive, ask them to raise their contraceptive high in the air.
36 |
Please note:
Please always go through all contraceptives raised by the participants commenting on whether the statement actually applies to this contraceptive, correct misconceptions and use probing. Give clear messages!
Statements
Correct answers
Is your contraceptive available in Nepal at no
or low cost?
All
Probe: Are these contraceptives free of costs at
health facilities?
Yes
Probe: Where can you get condoms? Are they
free of costs?
Condoms and the OCP are also available from FCHVs
for free and at health facilities and at local pharmacies at low costs.
If you are suffering from diarrhoea or vomiting
which contraception is not safe anymore?
OCP
Can you become pregnant when you stop using
your contraceptive?
All
Is your contraceptive only used by women?
All: except Condom
Probe: Does this mean that only girls and women
are responsible for contraception?
No, preventing an unwanted pregnancy is a joint
responsibility of both partners and not only of the
girl. At the same time, it is the right of every girl or
woman to decide if she wants to use contraceptives
and which ones, even if her partner/husband/parents
do not agree.
Which of your contraceptives can you use in an
emergency?
Emergency Contraceptive Pills
Probe: In which cases would you need to use
Emergency Contraception?
Most common reasons: if a condom broke, which very
rarely happens, or if you did not use any other form
of contraception during sex.
Probe: Would you use Emergency Contraception
as a regular method of contraception?
No. It has unpleasant side effects, you should think
about contraception together before you have sex. It
is only for emergency situations such as those we
have just discussed.
Probe: How long after the unprotected sex can
you use Emergency Contraception?
It is only effective within 5 days after unprotected
sex. Take the Emergency Contraception as soon as
possible, the longer you wait, the less effective it is.
Probe: Where can you get Emergency Contraception?
At the pharmacy at small cost (E-Con, I-Pill) or at
the health facility.
Has your contraceptive the double function of
preventing both from becoming pregnant and
getting infected with HIV and most other STIs?
Condom
If you have vomited or had diarrhoea, you should
use a condom when having sex for at least 7 days
after vomiting or diarrhoea to ensure that you don’t
become pregnant. If this happens you should consult
the instruction leaflet.
The condom is the only contraceptive which both
prevents from becoming pregnant and getting infected
with HIV and most other STIs.
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Please note:
Background Information for Facilitators: Usually the contraceptives are available at the following levels
of health facilities in Nepal:
Condoms: SHP, HP, PHCC, District Hospitals, Zonal Hospitals, Regional Hospitals
OCP: SHP, HP, PHCC, District Hospitals, Zonal Hospitals, Regional Hospitals
Injectables: SHP, HP, PHCC, District Hospitals, Zonal Hospitals, Regional Hospitals
Implants: HP, PHCC, District Hospital, Zonal Hospital, Regional Hospitals
IUCD: HP, PHCC, District Hospital, Zonal Hospital, Regional Hospitals
5) Probe: Are there any other safe methods to prevent pregnancy?
Answer: No, some people use calendar-based methods (trying to monitor the fertile
days based on a calendar or symptoms) or coitus interruptus (boy withdraws his penis
from his partner’s vagina, and ejaculates outside the vagina, keeping semen away from
her genitalia). Both methods are not reliable and not at all recommendable to prevent
pregnancy.
6) Wrap up this exercise by repeating three key messages, ideally through probing:
• You have the right to get information about contraceptives and to use contraceptives. Get information and counselling from a health facility nearby or use
condoms.
• When you stop taking contraceptives, your fertility comes back and you can
become pregnant if you wish.
• The condom prevents from becoming pregnant and getting infected with HIV
and most other STIs. This is why participants will learn about how to use a condom in the next activity.
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Content of 7 printed plastic cards:
Family planning device
Description and Message
Male Condom
• The condom is the only contraceptive which prevents both from becoming pregnant
and getting infected with HIV (the virus that causes AIDS), and most other STIs.
• It is easily available at low cost at pharmacies, corner-shops and it is free of cost
at government health facilities. You can also obtain condoms from your FCHV.
• The condom is put on the erected penis of the man; this is easy to learn.
OCP/The pill
• It is a packet of pills taken by women and should be taken daily always at the same
time. You need to use one package per month.
• Correct instructions on how to use the pill are always given on the instruction leaflet
in the pill box.
• OCPs do not protect against infections with HIV and other STIs.
• It is easily available at low cost at pharmacies and it is free of cost at government
health facilities. You can also obtain it from your FCHV.
Emergency
Contraceptive
Pills (ECP)
• ECPs are not a regular contraceptive but a backup method, e.g. when a condom
failed and/or when a couple had unprotected intercourse.
• Due to its side effects, it should be used only in cases of emergency and not as a
regular contraceptive method.
• ECP must be taken by the woman as soon as possible after the unprotected sexual
intercourse and no later than 5 days.
• ECP is available for free at health services or available at some cost at pharmacies.
• It offers no protection against infections with HIV and other STIs.
Implants
• The implant is a very safe and reliable contraceptive, used by women.
• It is inserted under the skin of the arm by a trained health worker.
• There are two types of implants available in Nepal: Jedelle offers five years and
Indoplant offers three years of contraceptive protection.
• Implants are freely available at hospitals, primary health care centres and in most
health posts.
• If a user wants to become pregnant, the health worker simply removes the implant
again.
Intrauterine
Devices (IUCD)
• The IUCD is a very safe and reliable contraceptive, used by women.
• It is a very small flexible device made of metal and/or plastic which is inserted
into a woman’s uterus through her vagina by a trained health worker.
• It protects against pregnancy for up to 12 years.
• If a woman wants to become pregnant, the trained health worker removes the IUCD
again.
• The IUCD is freely available at regional, sub regional, zonal and district hospitals,
primary health care centres and in most health posts.
Injectables
• Injectables are administered by a health worker into the arm or buttock of a woman.
• One injection prevents pregnancy for 3 months.
• The injection is administered free of charge at all levels of government health facilities or available at low cost at pharmacies.
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Please note:
Background Information for Facilitators on ECP which are of two different types:
• Regular combined oral contraceptive pills can also be used as EC: In this case, 4 tablets are taken
immediately after unprotected sex and 12 hours after taking this first dose another 4 tablets are taken.
Thus, a total of 8 tablets should be taken.
• The other is EC available in markets like E-con and I-Pill. It can be taken within 120 hours after unprotected sex.
Activity 2: Condom demonstration
10 minutes
• The condom is a special contraceptive as it prevents both from becoming
pregnant and getting infected with HIV and most other STIs. Each condom can only be used once.
Recommended
Position
• The use of a condom is easy and fun to learn.
Materials:
• Number of condoms: 100 (per event)
• Two wooden penis models
• Paper handkerchiefs (optional)
The two penis models and one condom are taken out of the bag. One facilitator holds the
penis (but not pointing it at the participants) and one facilitator holds the condom. It is
important that after this activity, all used condoms AND the penis models are put back in
the bag before the next group arrives.
Step-by-step guide:
Part 1: Demonstration of correct condom use
You briefly introduce the activity and explain that you will use a model penis made from
wood to demonstrate the use of a condom. Tell participants that penises have different
shapes and sizes, all forms are normal – no need to worry.
One facilitator holds the penis model and says that to use a condom, the penis needs to
be erected and the foreskin pulled back. The other facilitator demonstrates the seven
steps of the proper use of the condom and explains the steps at the same time.
1. The package: Check the package for damage and expiry date. Never use a damaged
package or a condom that is expired.
2. The opening of the package: There is a place from which it can be opened easily. Never
use sharp instruments or teeth or sharp nails. The condom could get a hole and
then break.
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3. Taking the condom out of the package: When the condom is taken out, put it on your
hand and check that the ring is on the outside of the latex. If it is on the inside then
blow into the tip of the condom to flip it around.
If you have already touched the tip of the penis with the condom, then realizing
that it is upside down – always use a new condom as semen could already be at the
condom!
4. Holding the tip: Pinch the little pouch at the end of the condom, so that there is room
for the ejaculate to go and hold the condom on the top of the penis. Probe: “Why is it
important that there is no air in the tip of the condom?”
5. Rolling it on the penis: Then roll it down to the base of the penis. If you want to use
lubricants, make sure that they are suitable to be used on condoms.
6. After the climax (ejaculation) the condom is removed: The condom has to be removed as long as the penis is still erect, otherwise semen can flow out and still get into
the vagina of the partner. Slide the condom off, avoid spilling semen.
7. The condom gets a knot for disposal: Knot it, wrap it in paper or put it back into the
condom package and throw it into the garbage bin (not into the toilet).
Please note:
You may use paper handkerchiefs to clean your hands afterwards. If you do that, also offer the handkerchiefs to the participants.
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Part 2: Practicing condom use
1. Tell the participants: “Now you can all practice the proper use of the condom with
our wooden models.”
2. Ask the participants to split into two groups by sex, e.g. one group consists of male,
the other of female participants. Ask the participants to form pairs of two participants.
Provide one pair in each sex group with the penis model and a condom.
3. Ask all pairs in both groups to practice condom use following the demonstrated 7
steps, one after the other. While one pair practices condom use the rest of the participants carefully observe the practice.
4. Each sex group is supported by one facilitator who carefully observes if the pairs are following the 7 steps of condom use. If there are mistakes, gently correct them and explain
the importance of the respective step.
5. When a pair has finished, it hands the penis model to the next pair and the facilitator
gives the pair a new condom package.
6. Ideally, all participants of each group practice proper condom use.
Closing
Thank the participants for sharing their knowledge and participating and encourage them
to find out more about contraceptive methods from their health worker!
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3.4Gender
• can differentiate between sex and gender.
• realize how gender roles influence the sexual and reproductive health and rights of individuals.
• know about support options for victims of gender-based violence.
Key messages:
• Gender is socially assigned roles, behaviours, attributes and responsibilities to
people based on their sex. It is imposed by society.
• Gender roles can place girls at risk of early marriage, early pregnancy and childbirth, infection with HIV and other STIs, sexual/domestic violence and rape.
• Gender-based violence is the extreme form of gender inequality. If you experience
such violence, use the existing support structures. If you witness it, try to offer support.
Welcome the participants at the station, introduce yourselves with your name and inform the
participants that at this station you will talk about males and females, girls and boys, about
their social status and relationship and ways to improve this relationship.
Activity 1: Difference between sex and gender
• Gender is socially assigned roles, behaviours, attributes and responsibilities
to people based on their sex. It is imposed by society and learned from an
early age.
4 minutes
Recommended
Position
• Gender roles can be changed over time.
Materials:
• 2 panels: one with “sex” and one with “gender” written on it
• 6 statements on sex and gender on laminated paper
Put the two panels “sex” and “gender” on the floor facing the participants.
Step-by-step guide:
1) Tell the participants: “In this first activity, we will talk about the difference in definition of sex and gender. ” Without using probing, explain what sex and what gender
means and the difference between the two concepts. You can use the information given
here, at the same time we recommend using your own words:
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Sex refers to the biological characteristics that define males and females, for instance their sexual organs.
These characteristics are present at birth and they do not vary across societies, cultures, or historical periods.
Gender refers to the socially constructed roles, behaviours, activities and responsibilities that a given society
or culture considers appropriate for men and women. These ideas are linked to the concept of masculinity
(what we see as manly behaviour) and femininity (what we see as feminine behaviour). This can be quite different across cultures and societies, e.g. how males and females should dress, what their tasks are within a
household, how they should act within marriage and sexual relationships. Gender roles can be changed and
do change over time.
Don’t worry if the group does not understand the idea at once.
2) Tell the participants: “Now I will read out a statement that either relates to the biological sex or a gender norm. If you think that the statement relates to the biological sex, please raise one hand, if you think, the statement relates to a gender norm,
please raise both hands.”
Statements
Correct answer
Females can give birth to babies.
Sex
Only males should initiate sex, girls should not express sexual desires.
Gender
Girls should be virgins before marriage.
Gender
Boys have penises. Sex
Females should take care of children and sick and elderly people.
Gender
Girls are expected to remain close to home.
Gender
3) If the participants are not clear, if a statement relates to the biological sex or a gender
norm, please promote a short discussion until you think the participants have understood.
If participants incorrectly classify a gender-related statement as a sex-related statement, ask “do you think that people in all ethnic groups in Nepal and in other
countries in the world will agree with that statement?
Wrap up this activity by telling the participants: “Biological sex differences are not
changing over time and they are universal. In contrast, gender roles vary from one
society/culture to another, or even between different ethnic groups in one society.
In addition, gender roles are changing over time.”
44 |
Activity 2: Causes and consequences of Gender-Based
Violence (GBV)
10 minutes
Recommended
Position
• Gender-based violence is the extreme form of gender inequality. If you experience such violence, use the existing support structures. If you witness it, try to offer
support.
• Gender norms, roles and relations that assign greater value and power to men increase
women’s risk of gender-based violence, which can contribute to poor sexual and reproductive health.
• Gender-based violence takes many different forms such as physical, mental or social
abuse.
• Gender-based violence is a crime.
• The impact of gender-based violence is far-reaching both for the victim and society.
Materials:
• 3 pictorial cards: a man beating his wife, rape, a girl leaving school after marriage
• 3 facilitator’s cards (with 3 questions each)
Hold the materials in your hand.
Step-by-step guide:
1) Inform the participants that now you will talk about the causes of gender-based violence, the consequences and options for what can be done to reduce gender-based
violence and to help those that are suffering from it.
2) Don’t use probing, shortly explain GBV:
Definition of Gender-based Violence (GBV):
“Violence is any act which intentionally causes physical, sexual or psychological harm. Gender-based
violence results from power inequalities based on gender roles and the dangerous idea that women are
worth less than men. Therefore, most often, girls and women are suffering from gender-based violence. It
is also gender-based violence if a man threatens a woman or violates her rights. Gender-based violence
both happens in private and in public life and it has serious consequences both for the victim as well as
for the society.”
Psychological and physical consequences of GBV:
Fear, low self-esteem/ inability to perform at ones best, depression, post-traumatic stress disorder (especially after rape or persistent physical violence or verbal abuse), alcohol/drug abuse, suicide, homicide
Sexual health consequences:
Infections with STIs incl. HIV, unwanted pregnancy, unsafe abortion, maternal death
| 45
3) Ask participants to share their ideas about examples of gender-based violence that
they have heard of or observed in the society. Make sure that common forms of
gender-based violence in Nepal are covered:
• husband beating wife
• sexual harassment
•rape
• girl trafficking
•teasing
• girl stopping school after marriage
4) Now tell the participants, that you will look at some types of gender-based violence in
more depth. Place the first case on the floor and ask the questions below, use probing
for discussion. Then go through the second and third case.
Case 1: Husband beating his wife
Question 1: Why does this happen?
Possible answer: Lack of respect for wife/women; anger that is not controlled;
alcohol misuse; fear of loss of control or power (these are no justifications for this
behaviour; e.g. as the man decided to drink alcohol, he is still responsible for his
behaviour! Violence does not solve problems, but increases problems and is a big
burden for each relationship.)
Question 2: What can YOU do when you observe such a situation?
Possible answer: Asking relatives to speak to the man/husband that this behaviour is
hurting his wife and is only increasing problems; joining hands with other members of the community who disapprove of this behaviour to confront the man/husband; informing the police.
Question 3: What support is available to women suffering domestic violence?
Possible answer: A woman can file a case at the police; a woman can contact support
networks (give examples if there are any specific ones available); a woman can contact the Woman and Child Office, they operate shelters for women suffering from
domestic violence.
Case 2: Rape of a girl
Rape is when a girl or woman is forced to have sex AGAINST her will.
Question 1: What are the consequences?
Possible answer: For the girl/woman: Depression, psychological distress, health consequences such as unwanted pregnancy, infection with HIV or other STIs;
For the men: Prison, stigma from family and society, expulsion from school, loss of
job.
46 |
Question 2: What can a girl do when a man approaches her and starts to sexually
harass her?
Possible answer: If a man approaches a girl and starts to sexually harass, the girl
should shout very loudly “No”. Physically defend herself. The girl should be assertive and say that rape is punishable and that she will file a case.
Question 3: What support or help is available to women who have been raped?
Possible answer: A woman can file a case against the man at the police, she can go
alone or with relatives or a friend. She should go for a medical examination because
the medical record is important evidence for her case. Later on, she should get a
pregnancy test to confirm whether she is pregnant, and, if necessary, consider using
safe abortion services. She should also consider an HIV test.
Case 3: A girl leaving school after marriage
Question 1: Why does this happen?
Possible answer: Pressure from family/parents in law to take over household work;
preference for investing in education of boys rather than girls
Question 2: What are the consequences?
Possible answer: Less choice and options for girls to choose further education and
professional careers; early pregnancy; dependence on family/husband/parents in law
Question 3: How we can prevent this?
Possible answer: Join hands with others in the community, e.g. friends who are
against this; ask the school to conduct local campaigns to keep girls in education
(even after marriage)
5) Wrap up the activity by telling the participants “GBV should be stopped at home,
school and society. Therefore, if you experience or observe any violence take an action to report or safeguard yourselves and others.”
Point out that there are currently still very few services available for girls or women
suffering from physical violence by male family members and that it is good to seek support from friends and other relatives.
Activity 3: Now and tomorrow: changing gender roles in
our Nepali society
6 minutes
Recommended
Position
• In Nepal, the access to and control over resources is often limited for women. And often, women are not allowed to take decisions on whether they would like to
get married, use contraceptives or visit health services, even though it is their legal right
to only marry if they want to and to use contraceptives and visit health services.
| 47
• Discrimination based on gender roles can place girls at risk of early marriage, early pregnancy and childbirth, infection with HIV and other STIs, sexual/domestic violence and
rape.
Materials:
• 5 pictorial cards: female building-site supervisor, female police woman, female VDC
chair/secretary controlling the budget of the VDC, woman at a cooperative being given
money by the trader; husband feeding a child with a spoon
Keep the 5 pictorial cards in your hand, don’t show them to the participants
Step-by-step guide:
1) Ask the participants: “Who typically controls the money and income in a household? Men or women?”
Discuss, also referring to the following possible answers: In the majority of households, men are in charge of managing and spending the money generated by the
members of the household, also in the frequent case that the women in the household have also (considerably) contributed to it. Control over the money helps
maintaining the power status of men and reduces the power of women. In some
ethnic groups, however, it can also be the women who are in charge of money. Generally these groups treat men and women more equally.
2) Then ask the participants: “Who makes decisions about a woman’s health?”
Discuss, also referring to the following possible answers: In the majority of households, a man (a father, a husband or a son) is involved in the decision-making on
a woman’s health. For example, about whether a girl/woman is allowed to visit a
health centre, whether she can access and use family planning methods. This can
have far-reaching and often very negative consequences on a woman’s health status.
Furthermore, it is a violation of the woman’s rights, for example the right to decide
how many children she wants and the right to safe abortion.
3) Put the five pictorial cards on the floor and ask the participants, what they see on these
pictures, what they think/feel about these pictures.
Discuss, also referring to the following possible answers:
• Women can have the same jobs as men.
• Women should be able to choose a job they like.
• Women can work outside the home, get paid for this work and have professional
careers, become independent from their husbands.
• Women who have a financial income can more easily make decisions about their
own health.
48 |
• Men can also care for the children and do work in the household. Men often appreciate caring for the children.
• If men work in the household, they reduce the burden of women, so that the
women can rest/work less or invest time in their education.
• When partners support each other this way, this can improve their relationship
and also improve the economic situation of the household.
4) “What needs to be done, so that women can have better jobs and earn money for
themselves? And so that they can take their own decisions regarding their health so
that they are better protected?”
Possible answer: Education! Girls should go to school, stay in school, complete
higher education and vocational or academic training. Encourage the girls to stay
in school, even if they are married!
5) Wrap up this part of the activity by asking participants to think about these questions
when looking at their own household and their own situation: Can you think of
women or do you know women who are educated and earn money? What are your
dreams about your future? What would you like to change?
Closing
to be the generation where gender-based inequality and violence will be history!
| 49
3.5Sexual and Reproductive Rights
• know about their essential sexual and reproductive rights.
• know that discrimination of people is a violation of these rights.
• are aware of options for support they can give to vulnerable members of the community.
Key Messages:
• Adolescents have the same sexual and reproductive rights as everybody else, more
specifically the right:
1) to information about sexual and reproductive health issues,
2) to access safe, effective, affordable, acceptable and confidential health care services
including contraceptives and safe abortion services,
3) to develop their sexual orientation.
• A girl or a woman has the right to determine when, how often and if at all she
would like to become pregnant.
• You have the right to say no to sex.
• People who are discriminated against (people living with HIV, gay or lesbian people, third gender, single women, unmarried mothers, etc.) could lead a happy life if
they were accepted by the community and offered appropriate support if needed.
the participants that at this station, they will learn about their sexual and reproductive
rights. These rights are based on and are part of human rights and included in the Nepali
constitution and apply to everyone, including adolescents!
Activity 1:
Introduction to sexual and reproductive rights
• Adolescents have the same sexual and reproductive rights as everybody else,
more specifically the right:
1) to information about sexual and reproductive health issues,
2) to access safe, effective, affordable, acceptable and confidential health care services
including contraceptives and safe abortion services,
3) to develop their sexual orientation.
• A girl or a woman has the right to determine when, how often and if at all she would
like to become pregnant.
50 |
4 minutes
Recommended
Position
Materials:
• 5 big cards listing the rights without examples on the back
• 5 big cards listing the rights with examples on the back (cards for facilitator)
Hold the 5 cards for participants and the 5 facilitator’s cards in your hand.
Step-by-step guide:
1) Hand out the cards with the five key sexual and reproductive rights chosen for this
activity to 5 participants, the first three cards should ideally be given to girls, the last
two cards to boys. Ask each person to read out loudly what it says on their card and ask
them to hold the card during the activity.
The cards read:
1. I have the right to contraception
2. I have the right to safe abortion
3. I have the right to say no to sex
4. I have the right to develop my own sexual orientation
5. I have the right to privacy when receiving health services
2) Ask the participant holding the first card to explain what the statement means to him/
her, and to give some examples of that right. Support participants when you see that
they have difficulties by asking the larger group and by probing questions or giving an
example. Examples are given on the back of each facilitator’s card but of course if you
have some additional ones, please feel free to probe for them. Go through all 5 rights
one by one, keeping an eye on the time limit though.
3) End with sharing that “everyone has these rights, also each adolescent, each one of
you has these rights”. Add that there are many more rights you have in view of your
sexual and reproductive health, which you can find in the booklet.
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Right
Possible examples to be collected from the participants
I have the right to
contraception.
If I go to a health facility I should get a family planning device regardless of
whether I am married or unmarried and regardless of my age.
A girl has the right to choose the contraceptive she wants to use and to decide
whether to have a baby or not. To talk about contraception/family planning with
her partner is important. However, the girl has the right to use contraceptives
even if her partner/husband/parents in law do not agree.
My parents-in-law should not force me to have a baby if I do not want to.
I have the right to use contraception to protect myself against unwanted
pregnancy. Condoms at the same time prevent an infection with HIV and most
other STIs.
I have the right to
safe abortion.
I can have an abortion in the first 12 weeks of pregnancy.
In case of rape or incest, I can have an abortion in the first 18 weeks of
pregnancy.
In case the baby is very sick or making me very sick, I can have an abortion
any time during pregnancy.
If a girl is less than 16 years old, she has to take a guardian (someone above
16 years) to give consent to the abortion. If the girl is 16 years or older, it
is sufficient if she gives her consent (i.e. she can go alone if she wants to).
Abortion services are confidential – a health worker is not allowed to tell
anyone that I had an abortion (see also Right to privacy).
I have the right to say
no to sex.
My husband/boyfriend does not have the right to force me to have sex if I do
not want to.
I can say no to sex if I do not feel like it.
I have the right to develop my own sexual
orientation.
Some women’s romantic and sexual attractions are primarily associated with
other women (lesbian) and some men are primarily attracted to other men
(gay). Being attracted to the same sex is called homosexuality. If I feel that
I am homosexual (gay/lesbian) then I should be able to express this freely
in my community without being scared of being expelled or physically or
emotionally hurt.
I should not be forced to marry someone of the opposite sex if I am attracted
to the same sex.
I have the right to
privacy.
If I ask a health worker for condoms, he or she is not allowed to tell anyone
about this.
If I seek counselling or treatment services at the health facility, I should be
able to do this alone with the health worker without anyone listening.
If I am HIV positive/have an STI, no one besides me has the right to tell other
people about my condition.
52 |
Activity 2: Case studies on sexual and reproductive
rights
10 minutes
• People who are discriminated against (people living with HIV, gay or lesbian people, third gender, single women, unmarried mothers, etc.) could lead a happy
life if they were accepted by the community and offered support if needed.
Recommended
Position
• Discrimination of people is a violation of their sexual rights.
Materials:
• 3 case studies printed on laminated paper
• 3 pictures with faces of young people (cartoon) associated with the case study
• 5 facilitator’s cards each showing one of the questions and answers
Hold the cards with the case studies as well as the facilitator’s cards in your hand. Put the
pictures with the faces of young people on the floor upside down.
Step-by-step guide:
1) Explain to participants that you have brought along three case studies to help them to
understand better the concept of sexual and reproductive rights. Ask one of them
to draw/choose one case study. Once a case study has been chosen, put the picture of
the respective person on the floor, then read the story to the group as is written on the
facilitator’s card:
Lakshmi
Lakshmi is 16 years old and lives in a village. She recently married and moved into her husband’s home.
Her mother-in-law told her to have a child soon, otherwise she would be considered infertile and thrown
out of the house. Lakshmi wanted to wait a few more years before having a baby as she wanted to finish
her secondary school first. Her mother-in-law, however, did not allow her to visit a health facility, which
made it difficult for her to access family planning methods. Her 22-year-old husband also wanted to have
a baby soon, so she became pregnant at the age of 17.
Sushmita
Sushmita is 17 years old and one year ago had sex with her boyfriend although they were not married
yet. Her boyfriend put a lot of pressure on Sushmita by threatening that he would leave her if she refused
to have sex with him. They did not use any contraception, and she became pregnant. She was so afraid
and ashamed that she didn’t tell anyone. She also didn’t know that she would have been able to have an
abortion at the health centre. When the community found out that she was pregnant without being married,
people stopped talking to her. Her parents threw her out of the house. She now lives with her 3 month old
daughter in very poor conditions and doesn’t know how to cope. She is desperate and even thought about
selling her body to earn a little money to feed herself and her daughter.
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Kopil
Kopil is 19 years old and has already for a long time felt that he is attracted to other men. He knows that
he is gay/ homosexual. He told his parents about how he feels and now they are pressuring him to marry
the neighbour’s daughter whom he is not attracted to. His best friend knows that he is gay but does not
know how to help him. He thinks now of running away from home either to Kathmandu or to India to try
and live a life that allows him to love whom he wants to love.
2) After reading the story, ask the following questions:
Question 1:
“Can you tell me, which sexual and reproductive rights are violated in this case?”
Probe for answers.
Answers:
Case 1: The right to contraception: more specifically, the right to information about
and access to contraception and the right to access health facilities for information,
advice and family planning devices. The right to safe abortion (if the girl would
have wanted to).
Case 2: The right to determine whether to have sex or not; the right to contraception and safe abortion services.
Case 3: The right to develop your own sexual orientation, the right to choose your
partner yourself.
Question 2:
“Who is violating the rights of Lakshmi, Sushmita or Kopil?” Probe for answers.
Answers:
Case 1: mother-in-law; husband
Case 2: boyfriend, community, parents
Case 3: parents
Question 3:
“Why do you think they are violating the rights?” What are the reasons? Probe for
answers.
Possible answers:
• Shame of behaviour of Lakshmi, Sushmita or Kopil that is brought onto the family
is felt
• Fear of people who are different, do not fit into a society’s concept of normality
Always probe on and stress the idea, that in reality Lakshmi, Sushmita and Kopil do
not represent any danger for the society.
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Question 4:
“What can you do to support Lakshmi, Sushmita or Kopil?”
Probe for answers including whether they know about the availability of local services
(which ones do they know and where are they?). Mention those services that you
would like to refer to.
Possible answers:
Individual level: inform them about their rights and the availability of contraception,
safe abortion and other services (also for LGBT) available at (adolescent-friendly) health
facilities; find out where these services are and accompany them to go to these services
Community level: get together in a group of people and think about how to change
the situation in the community in an organized manner (i.e. through activities such as
public speeches, orientations, peer-to-peer); link up with change agents/like-minded
people in the community (teacher, health worker, youth organizations) to get advice and
support, etc.
Question 5:
“What would the situation of Lakshmi, Sushmita or Kopil be like now if their
rights had not been violated and they would have had community support?”
3) End the activity on a positive note saying that we all have the chance and responsibility
to ensure that we are not violating other people’s rights.
Activity 3: Puppet theatre
6 minutes
• You have the right to information about sexual and reproductive health issues.
Recommended
Position
• You have the right to contraception.
• You have the right to privacy.
Please note:
After the serious activity that explored sexual rights violations of individuals by family, community or
society, this activity is supposed to be fun and optimistic.
Materials:
• 2 Puppets (one of a boy/man and one of a girl/woman)
• 2 Puppets (one of a girl and one of a doctor)
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Have the puppet ready next to you on the floor.
Step-by-step guide:
ROLE PLAY 1: Taking action to prevent unwanted pregnancy
Please note:
This role play should be a positive demonstration of an ideal encounter between a health worker and an
unmarried girl who wants to get advice on family planning. The health worker is ensuring that the girl can
claim her rights by being non-judgmental about her marital status/age and by appreciating her taking decision about preventing an unwanted pregnancy. The health worker is a role model for how a health service (in
this case family planning counselling) should be like if it is adolescent-friendly. This role play has the aim to
increase demand for adolescent-friendly services and should encourage adolescents to seek health services.
Step 1: Explain that you will now show a puppet play between an unmarried adolescent
girl (called Rita) and a health worker. Rita is visiting a health facility and is talking
with health worker Mr. Shah:
Act out the situation by inventing your own words for the following situation:
Puppet girl: Rita has visited a health facility for the first time. She is in a sexual relationship with her boyfriend
and is worried about becoming pregnant. She is worried that Mr. Shah will not help her and that her community
and parents will know about her visit at the health facility.
Puppet man: Mr. Shah says that Rita had made a very good decision by coming to the health facility. He ensures her that her talks with him will be kept confidential and nobody will learn about the fact that or why
she had visited the health facility. He takes her to the separate room and listens to her. He advises her to use
a condom every time she and her boyfriend have sex and gives her a handful of condoms. He also encourages
her to bring her boyfriend next time so that they can talk about family planning choices together, but that she
can of course also come alone if she prefers to do so.
Discuss with the participants:
1. “What has happened in this situation?”
2. “Which rights are shown in this short play?” (right to information, right to contraception, right to privacy)
Step 2: Finish the activity by saying: “As you have seen, health workers should provide
you with information and contraceptive choices in a safe and private environment and
you have the right to claim this from your health worker.”
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ROLE PLAY 2: “How to say yes and no” (sexual decision making)
Please note:
The role play should be a role model of a couple communicating about needs and wishes by demonstrating
that talking about sex is good and that it is important to make clear when you are not in the mood for sex.
It strengthens your relationship if you are able to talk openly with your partner about what you like and what
you don’t like. Also girls and women can talk about their wishes. If you say no, give some positive feedback
about your partner, the feelings for him/her, appreciate his/her trust and openness, so that it is easier for
him/her to hear your “No”. Therefore, it is crucial, that the role play shows an ideal example of a caring
relationship, the man does not react disapprovingly when the woman talks about her wish to have sex!!!
You can use other words which mean “to have sex”. However, it is important that the meaning of these
words is clear, so that there is no confusion about the situation that one of the partners wants to have
sex while the other one is not in the mood to have sex.
Step 1: Explain to the participants that you will now play a scene from a house, showing
the couple Kamala and Ram. When mentioning the names, show the hand puppet to the
group.
Act out the situation by inventing your own words for the following situation:
Puppet girl: Kamala is in a very good mood and has been dreaming about Ram all day. She felt very happy in
her dreams. When he comes home, she wants to have sex with him and she shows/tells him.
Puppet Boy: Ram is very impressed and happy that Kamala just told him she wants to have sex right now. But he
is tired and worried as his father is sick. He is not in the mood to have sex. He tells her in an appreciative way.
Discuss with the participants:
1. “What has happened in this situation?”
2. “Which right is shown in this short play?” (The right to say no to sex if you don’t
want to have sex.)
Step 2: Finish the activity by saying: “As you can see, both boys and girls are sometimes
in the mood for sex and sometimes not. Having sex should always happen when both
WANT to have sex and should never be forced or coerced. If you are not in the mood to
have sex, you have the right to say NO. It strengthens your relationship if you are able
to talk openly with your partner about what you like and what you don’t like. If you say
no, give some positive feedback about your partner, the feelings for him/her, appreciate
his/her trust and openness, so that it is easier for him/her to hear your “No”.”
Closing
to secure their own sexual and reproductive rights!
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4
Chapter
Facilitation skills
The success of SangSangai in promoting opinion and experience exchange among participants and in making them feel safe or even at ease with talking about sexual and reproductive health and rights issues mainly depends on the communication skills of the facilitators.
Therefore, the manual includes this important chapter which serves as a guidance for facilitators on how to continuously improve their skills. We would like to encourage facilitators
to read this chapter several times, to discuss it with other facilitators or coordinators and to
continuously reflect on their facilitation skills and attitude.
In the training SangSangai facilitators raised their awareness about the special skills and
attitude, which can create a constructive and open environment for SangSangai. In the
following, we provide guidance to the facilitators on the most important characteristics of
SangSangai facilitation. As we directly address facilitators with our recommendations in
this chapter of the manual, we will in the following address the facilitators by using “you”
instead of the abstract “the facilitator”.
Guidance 1: Be dialogue-oriented by using participatory methods
and asking questions.
The following table illustrates main differences between traditional teaching and participatory methods:
Traditional Teaching
Participatory Methods
teacher’s role is to tell students
what they need to know
facilitator’s role is to ask questions, and to facilitate discussions
the knowledge and experiences of
the teacher count more than those
of the students
both facilitator and participants are knowledgeable and experienced: the inputs of participants matter, are even crucial for the
learning process
teacher shares her/his knowledge
with the students by lecturing
everyone reflects on her/his own, then shares her/his ideas, experiences, and expertise
students are passive, just listening
and taking notes
participants are active and analytical, asking questions and exploring alternatives
students learn the right answer
from their teachers
participants develop their own answers - indeed, there may be
many different answers
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It is important to remember that you are not supposed to lecture and provide your information, but that you use the activities as a means to encourage participants to openly
exchange their opinions, raise their concerns, share their knowledge, ask questions. Do
your best to make the experience to talk about sexuality and related topics a positive one
for the participants. Only share your own knowledge in case no participant can provide
this information.
Interactive and entertaining discussions allow participants to deal with the topics in a cognitive, emotional and behavioural dimension and take their own decisions. Participatory
methods promote the ability of participants to reason, to analyse problems, and to work
out their own solutions.
Useful types of questions for SangSangai:
Open Questions
You ask for
Example
Answers have one or
more full sentences
Opinions
What is your opinion about ... ?
• If you want to go
more into detail
Reasons
Why do many adolescents do not use contraceptives?
Conditions
Under which conditions is sex safe?
Methods
How do you use a condom?
Value judgments
Would you have taken the same decision for yourself?
• If you want to hear
opinions
• If you want to promote analysis and
creativity
Closed Questions
Example
You can answer with one or a few words.
Can condom use prevent getting pregnant?
• If you want a quick response to a question
on knowledge
Where is the nearest health center?
• If you want a clear answer
Can tears transmit HIV?
• If you want to get a quick group feedback
Do you agree that using contraceptives is legal in Nepal?
The mix of questions is important and you will gradually get a good sense of when to ask
which type of question. The following types of questions are not useful in the SangSangai
context:
Manipulative/Suggestive Questions: I assume that all of you know how to use a condom?
This type of question will elicit a ‘Yes’ answer even if a participant does not know the answer and therefore you are bypassing the real information needs of the participants.
Provocative Questions: So, you do not care about getting infected with HIV?
This type of question will bring a participant into a defensive position and implies a moralistic judgment (see below).
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Guidance 2: Work on your attitude towards participants.
Communicate with respect & appreciation towards participants
What does this mean?
• Take their ideas, comments and questions serious
• Support them as a partner
• Offer ideas & recommendations the adolescents are free to follow or not
React in a tolerant and non-judgmental way to attitudes you do not agree with
Does this mean that you do not show your personal values? No!
• Pay a respectful and emphatic attention to the participant with this attitude.
• Ask questions to find out more about his/her underlying needs (please see below).
• Ask questions to promote him/her to consider the long-term consequences of his/her
attitude or behaviour.
• Be honest, utter your personal values, e.g. “In my relationship, I often look after our son
if my wife is busy. It is important for us, to support each other.”
• Do not judge on the other person, i.e. do not use “moralistic judgments”. Only utter
“value judgments” referring to your personal values. The following table illustrates the
important differentiation between value judgments and moralistic judgments:
Focus of
Attention
Aim
Value Judgment
Moralistic Judgment
Statements on which values (needs) are
important for me personally,
Generalistic judgment on another person or
his/her behaviour:
and if/in how far a specific behaviour fulfils
these values (needs)
“This person is + judgment”
Understanding each other.
Make others change their behaviours because
of feelings of guilt/shame/punishment or
pressure.
Being in connection with the other person:
we can listen openly to each other.
Example
“This behaviour is + judgment!”
“I would use a condom, being safe is
important to me!”
“You are careless!”, “This behaviour is
irresponsible!”
“Me personally, I want my partner to respect
my decisions.”
“This relationship is terrible!”
“I am not convinced that staying abstinent
can work on the long-run.”
“This idea is unrealistic/short-sighted.”
“Teenage Pregnancy is bad.”
“If I was in her position, I would finish my
secondary school first, because I want to have
a professional career!”
Change from serious to humorous/easy as appropriate, e.g. when talking about the
pleasant aspects of sexuality.
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Guidance 3: Deal with challenging behaviours of participants in
a constructive and effective way.
During SangSangai events, you will experience all kinds of different and sometimes challenging behaviours of participants. In order to manage these situations in a constructive
and effective way, try some of the strategies listed below. We also recommend exchanging
experiences with other facilitators on successful facilitation methods in these challenging
situations.
Challenging Behaviours
Facilitation Techniques
Confused Participant
• Ensure that you use appropriate language
• Ask peers to help to clarify
• Provide short proper information
• Ask to refer to IEC materials
• Request to meet after SangSangai
Aggressive Participant
• Appreciate contribution
• Don’t get irritated, stay calm, smile
• Do not use offensive language
• Involve peers
• Give special task (recognition)
Expert Participant contributing a lot
• Recognize contribution, then ask others
• Give special task
• Emphasize that we are all learners
• Call on his fairness and responsibility for others, give others a chance to
contribute
Talkative Participant
• Ensure the participant that you have understood his/her idea, e.g. by repeating it
• Give special task
• Remind of time limit
• Ask him/her to come to the point
• Call on his/her fairness and responsibility for others, give others a chance
to contribute
Conflict among Participants
• Respect opinions of both participants
• Ask questions to both
• Take them apart
• Involve them in tasks
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Passive Participant
• Create positive environment
• Motivate by appreciation
• Encourage, make participants feel comfortable
• Role plays, games, cards help you to involve them
• Ask direct simple questions
• Be patient when waiting for their answers, they might need a little more
time to open up
• Convince by giving examples
Participant repeatedly
asks questions
• Appreciate interest + bounce questions to peers
• Postpone questions for later
• Refer to IEC materials to be distributed later
Disruptive Participant
• Appreciate the contribution
• Request not to distract the attention, so that all can focus
Dominant Participant
• Appreciate the contribution
• Request to give chance to others to contribute, ask him/her to “Let’s hear
all!”
• Inform that you would like to give equal time to all
Participant with emotional
outbreaks (crying)
• One facilitator takes the participant to one side
• Refer the participant to coordinator or teacher to look after him/her, he/
she is always welcome to come back
• Join co-facilitator to continue with SangSangai activity
• Try to keep the attention of the group on the activities
Physically unwell participant
• One facilitator takes the participant out of the group and informs the
coordinator or teacher
(it can happen that a
participant faints or feels
unwell)
• Let the participant rest and provide water, biscuits, chocolate and ask to
rejoin when feeling better
• The other facilitator remains calm, stays with the group and continues with
the activity
Guidance 4: Use probing.
Probing is a very useful method in SangSangai which supports you in situations where you:
• want to understand a participant’s statement better.
• would like to find out the underlying ideas of a statement.
• want a participant to question his statement.
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Purpose of Probing
Participant’s Statement
Appropriate Probing Question
Overcoming Barriers
That will not work!
What could be done to make it work?
Being more precise (understand better; find out
the underlying ideas)
Condom use is difficult!
What do you mean by “difficult?”
All contraceptives are complicated
to use!
Which contraceptives do you think of
when saying that?
Reveal assumptions
(question statements)
My partner would never accept using
a condom!
What makes you think that?
Why do you think so?
Probing is particularly helpful, when you would like to understand why a participant has
a certain opinion or is engaged in a certain behaviour, i.e. when you would like to understand his/her underlying needs.
Please note:
Only if you understand the needs a person tries to fulfil with a certain (unhealthy) behaviour, you can
support this person in finding alternative healthy ways of behaviour which can fulfil his/her current needs.
As illustrated below, the same statement can have very different underlying needs, and you
will only discover them by probing. In order to demonstrate this, we have included some
examples:
Statement of Participant 1: “I will never use condoms!”
Facilitator: “Why do think, that you will never use condoms?”
Participant 1: “There are no condoms in my village, so I can´t get any.”
You have discovered: The participant probably feels frustrated, as he would like to use condoms, but does not know, where to get them
• provide the participant with this knowledge by brainstorming with the group and adding suggestions
Facilitator to the group: “What do the others think: Where can you get condoms? In the
health centre?”
Participant 2: “My girlfriend would be really upset if I proposed to use condoms!”
You have discovered: The participant probably feels concerned, that the relationship with
his girlfriend might suffer, if he proposes condom use
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• invite the participant to reflect this assumption and find out, whether it is right. He
needs a strategy, how to be able to both have a good relationship with his girlfriend
(value 1) and to protect his/their health by practicing safe sex (value 2).
Facilitator: “Why do you think that your girlfriend would be upset?”
Participant 2: “I guess, she thinks that condoms are only for people with many partners and that I do not care for her!”
Facilitator: “Have you ever asked her, what she thinks about condoms?”
Participant 2: “No!”
Facilitator to the girls in the group: “What would you think if your boyfriend proposed
to use a condom?”
Girl 1: “I would agree as this way we can both be safe from HIV and STI infections!”
Girl 2: “I would be relieved as he would also take responsibility to prevent that I become pregnant, in case I forget the pill.”
Facilitator to Participant 2: “Would it be possible for you to ask your girlfriend, what
she thinks about condom use?”
Participant 2: “Yes, this way I can find out what she really thinks and tell her, why I
would like to use condoms!”
Participant 3: “I don´t want my parents or the community to find out, that I am meeting a girl!”
You have discovered: The participant is probably afraid, that the relationship with his parents and community members might suffer when they know that he is meeting a girl
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• make the participant think about a strategy, how to be able to both have a good relationship with his parents and community members (value 1) and to protect his health
by practicing safe sex (value 2).
Facilitator to the participant: “I assume, that a good relationship with your parents
and the community is important for you and that you fear that they might think bad
of you when they will observe you buying condoms or when they will find the used
condoms?”
Participant 3: “If I buy condoms in a shop, everybody will talk about me and my parents will know immediately!”
You have discovered: The participant is obviously worried about being observed when buying condoms, not about how to dispose them. Support him in finding a way to get condoms without anybody noticing.
Facilitator to the group: “Do you know where to get condoms in an anonymous way?”
Please note:
The participants are always free to decide if they want to change and adopt the healthy behaviour. It is
more likely that they decide to do so, if the healthy behaviour is meeting their current individual needs.
Guidance 5: Keep in mind the following do’s and do not’s.
This list of Do’s and Do not’s was collected based on observations during the training of
SangSangai trainers. It provides valuable examples of what to focus on and what to avoid.
The Do’s:
Probing! Probing! Probing! – The participants often already have a lot of knowledge, only explain something
if really no one in the group knows it.
ASK questions, be PATIENT, calm, relaxed, wait a little and LISTEN! Sometimes participants need a little
time to think about your question.
Technical knowledge: It is your responsibility as a facilitator to update your knowledge on aspects that you
are not yet clear about, there are plenty of sources of information that you can consult (e.g. the internet, colleagues, technical experts).
Become confident with the key messages of the station & internalize them by going through the facilitator’s
handbook very carefully, step by step.
Regularly go through your facilitator’s handbook also after your facilitation to check whether you have
followed all the steps of the activities and whether you have delivered the key messages.
Be aware of which messages you are giving!
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Voice: Be aware of your voice and check if the participants can hear you. Be also aware of the voice of
the participants if they say something, can the others in the group hear them?
Rapport with the group: Be interested in what your group has to say! Watch their body language: Did they
really understand what you had to say or are some not clear?
If a participant asks questions or gives wrong answers: be appreciative, make him/her feel comfortable,
correct wrong information in a way, which is not embarrassing for the participant.
If all participants answer correctly during the leg voting games, still probe for the reasons for this.
If you finish early, keep the participants engaged for the total period of 20 minutes (or 23 minutes), e.g.
go more into detail or ask them if they have any more questions and answer them.
Ensure that you involve all participants, pay attention to where you are standing and to your body language
(do not exclude participants by standing in front of them).
Use the materials of your activity in a way that they are visible for all participants all the time (e.g. HIV
station, Sexual Health).
Tidy up all materials after each activity and after you have finished the station. Ensure, that during your
facilitation no materials of another activity are distracting the attention of participants (e.g. wooden dildos
standing around).
Tell the participants which one is their next station and where they can find it.
Practice self-reflection and write down what you can improve the next time (e.g. in a diary).
The Do Not’s:
Do not let participants read out statements individually or together.
Do not let participants repeat jointly what you have just said – this is imposing & not participatory!
Do not reinforce misconceptions, e.g. by elaborating on the fact that menstruation is perceived as something
dirty in the Nepalese society, rather ask openly: “Is menstruation something unclean?” (particularly, if the
participants do not mention these misconceptions themselves)
Do not criticize the participants for laughing, rather find out, why they are laughing.
Do not ask only one or a few participants to demonstrate or practice condom use.
Avoid suggestive questions where the participants are supposed to think for answers.
Do not give different instructions to the activity: When one of the facilitators has already explained the
activity, do not explain it differently. If it was not understood by the participants, explain again the same
process as the first facilitator did. Listen to each other!
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Guidance 6: Be aware of the impact of your verbal and nonverbal communication.
Verbal Communication
SangSangai addresses some very sensitive issues. Please be aware that your choice of words
greatly influences how well participants will accept the messages given and how comfortable they will feel. Choose terms that are acceptable and understandable for adolescents.
If your words embarrass, hurt or scare the participants they will become unreceptive to or
even reject the information given. Also, encourage the participants and support them in
using a neutral language free from shyness, embarrassment and guilt as well as offence and
indecency. Again, do your best to make the experience to talk about sexuality and related
topics a positive one for the participants.
Non-verbal Communication
Non-verbal communication encompasses ones facial expressions, gestures, posture, eye
contact, handling of objects, choice of clothes and intonation. Often, non-verbal signals
are given unconsciously. They are perceived as an authentic indicator of our personality,
emotions as well as the attitude towards things, issues being discussed and the person(s) we
are communicating with. Therefore, be aware that you continuously pass on messages nonverbally which might even conflict with the intended messages of the station; negatively
influence the facilitator’s credibility or the participants’ motivation to accept the information given. If skillfully applied in a conscious way, non-verbal communication on the other
hand can greatly support you in favour of motivating, engrossing and encouraging the
participants.
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5
Chapter
Monitoring and supervision
SangSangai will be monitored in order to maintain and enhance the quality of the implementation. The monitoring also aims at the steering of implementation at national, regional and district level and can serve as a basis for joint review meetings.
The implementing agencies are responsible for monitoring, supervision and reporting on
SangSangai implementation. These responsibilities include the submission of a quarterly
report that documents and summarises the results of the pre- and post tests and the event
reports. The implementing agencies supervise as per the concept and format outlined here.
The following is an overview of the monitoring, reporting and supervision processes and
tools:
Supervision of SangSangai implementation
Part 1: Overview
1. Introduction
High quality of implementation is crucial for achieving the expected SangSangai results.
Regular supervision is necessary to guarantee this high quality. The supervision of SangSangai events ensures the quality of implementation through assessing and providing feedback
to the implementing agency and its facilitators, so that implementing agency and facilitators can improve the implementation practice if necessary. For this purpose, a team of
supervisors selected from the SangSangai trainers will be specifically assigned to evaluate
a) the facilitation skills of SangSangai facilitators and
b) the organization of SangSangai events.
They will report the results of their supervision to the implementing agency and to GIZ in
their quarterly progress report.
2. Aim
The aim of supervising SangSangai is to secure the quality of SangSangai and of its outcomes.
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3. Objectives
The objectives of SangSangai supervision are:
• Qualitative observation of the organization and implementation of SangSangai by responsible institutions.
• Delivery of feed-back, backstopping and advice on the spot concerning the organization
and facilitation of SangSangai as well as the identification of possible re-training needs
of SangSangai facilitators.
• Compilation of findings, challenges and lessons learned during implementation at the
field level to be included in the monitoring process and to deduce needs for action.
4. Outputs
The outputs of SangSangai supervisions are:
• SangSangai events are of a high quality
• SangSangai events follow a standardized model.
5. Expertise of Supervisors
SangSangai supervisors shall have:
• excellent knowledge of SangSangai methods, contents, objectives and messages.
• excellent knowledge in the field of sexual and reproductive health and rights, HIV/
AIDS and gender/gender-based violence.
6. Time Frame
When a new implementing agency with new facilitators starts implementing SangSangai,
they shall be supervised once within the first three months. After that, each team of SangSangai facilitators at district level shall be regularly supervised once to twice per year.
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Part 2: Method of supervision of SangSangai assignments
The supervision of SangSangai events yields best results if conducted with the support of a
video camera. However, if there is no video camera available, supervision may be conducted without video support. As a consequence, supervision steps are described for both ways:
for video support see sec. 1 below, if no video support is available see sec. 2 below.
1. Steps of supervision with video support
In order to guarantee more objectivity and to give facilitators a better instrument of selfevaluation, the use of a video camera during supervision is highly recommended. For
facilitators it is usually quite difficult to see their own mistakes. They tend to do their best
without being conscious of their performance. Watching themselves facilitate a SangSangai station on video will considerably help them to get a more objective view of their own
facilitation skills and techniques. This way they can raise their awareness of their needs and
areas in which they can improve their performance.
a) A SangSangai event is organized with the target group.
b) The supervisor observes logistic and overall management of the SangSangai event and
takes notes according to the “Questionnaire 1: Logistics and Management of SangSangai Assignments (event as a whole)” (see Annex 3.3).
c) At least one facilitation of each station is videotaped. When videotaping SangSangai,
following aspects shall be taken into consideration:
• Main attention shall be given to the performing facilitators, his/her words and gestures.
• The acoustics shall be good enough to clearly distinguish the words of the facilitators
on the videotape.
• Reactions of participants to the facilitators (to specific games etc.) shall also be included.
• To avoid the recording of the same group of participants throughout the entire
event, attention shall be given to cover all facilitators with different groups of participants (e.g. by movement of camera opposite to the direction of the SangSangai event
after the completion of a station).
d) In the meantime the supervisor observes all stations. The supervisor takes notes according to the “Questionnaire 3: Facilitation of SangSangai stations (supervision for each
individual station)”, (see Annex 3.5).
e) The video documenting the facilitation of all 5 stations is shown to the supervisor, coordinator and facilitators in a plenary session.
f ) Immediately after having seen the video with their own facilitation of a particular station, the respective facilitator(s) is/are asked to fill in the “Questionnaire 2: Facilitation
of SangSangai stations” (facilitator self-evaluation for each individual station, Annex
3.4) in order to evaluate his/her/their own facilitation and give his/her opinion about it.
70 |
g) A discussion on the performance of each facilitator follows. According to the specific
needs of the team, this feedback session can be organised either in a plenary session with
SangSangai coordinator and all facilitators present, or in separate sessions in which only
the supervisor, the coordinator and the relevant facilitator take part.
h) The supervisor always asks the facilitator for his/her comments on the given facilitation
first. Afterwards, the supervisor reports on the results of own observation and gives feedback. Constructive and detailed suggestions for improvements are given and discussed.
i) The supervisor asks the coordinator for his/her comments on the logistics and overall
management of the event. Afterwards, the supervisor reports on the results of own
observation and gives feedback. Constructive and detailed suggestions for improvements
are given and discussed.
j) After discussion, decisions are taken by a) the SangSangai coordinator and b) each facilitator as to how to improve their performance. The coordinator and the facilitators shall
commit themselves. This will be documented underneath the respective questionnaire
by the supervisor. A copy of each questionnaire will be given to the SangSangai coordinator to help him/her monitor the ongoing performance of his/her SangSangai facilitators’ team.
k) Results of supervision will be submitted to the implementing agency.
l) The implementing agencies will report on these findings in a consolidated manner in
their quarterly monitoring reports.
m)In case the results of supervision are not satisfactory, interventions shall be planned:
usually two to three days of re-training of SangSangai facilitators in those aspects where
they have shown a weakness. In case the evaluation results are very poor, a further supervision visit shortly after the re-training shall be planned.
2. Steps of supervision without video support
a) A SangSangai event is organized with the target group.
b) The supervisor observes logistic and overall management of the SangSangai event and
takes notes according to the “Questionnaire 1: Logistics and Management of SangSangai Assignments (event as a whole)” (see Annex 3.3).
c) The supervisor observes at least one facilitation of each station attentively. The supervisor takes notes according to the “Questionnaire 3: Facilitation of SangSangai stations
(supervision for each individual station)”, (see Annex 3.5).
d) Facilitators are asked to fill in the “Questionnaire 2: Facilitation of SangSangai stations
(Facilitator self-evaluation of station, Annex 3.4) in order to evaluate his/her own facilitation and give his/her opinion about it.
e) A discussion on the performance of each facilitator follows. According to the specific
needs of the team, this feedback session can be organised either in a plenary session with
| 71
SangSangai coordinator and all facilitators present, or in separate sessions in which only
the supervisor, the coordinator and the relevant facilitator take part.
f ) The supervisor always asks the facilitator for his/her comments on the given facilitation
first. Afterwards, the supervisor reports on the results of own observation and gives feedback. Constructive and detailed suggestions for improvements are given and discussed.
g) The supervisor asks the coordinator for his/her comments on the logistics and overall
management of the event. Afterwards, the supervisor reports on the results of own
observation and gives feedback. Constructive and detailed suggestions for improvements
are given and discussed.
h) After discussion, decisions are taken by a) the SangSangai coordinator and b) each facilitator as to how to improve their performance. The coordinator and the facilitators shall
commit themselves. This will be documented underneath the respective questionnaire
by the supervisor. A copy of each questionnaire will be given to the SangSangai coordinator to help him/her monitor the ongoing performance of his/her SangSangai facilitators’ team.
i) Results of supervision will be submitted to the implementing agency.
n) The implementing agencies will report on these findings in a consolidated manner in
their quarterly monitoring reports.
j) In case the results of supervision are not satisfactory, interventions shall be planned:
usually two to three days of re-training of SangSangai facilitators in those aspects where
they have shown a weakness. In case the evaluation results are very poor, a further supervision visit shortly after the re-training shall be planned.
Part 3. Questionnaires for quality assurance of SangSangai events
There are three questionnaires which are filled in:
Questionnaire 1: Logistics and Management of SangSangai Assignments (event as a
whole) (Annex 3.3)
The first questionnaire refers to the SangSangai event as a whole and is filled in by the
supervisor and signed by the supervisor and the coordinator. In this way, feedback is given
from the supervisor to the coordinator regarding logistics and the overall management.
Questionnaire 2: Facilitation of SangSangai stations (Facilitator self-evaluation of
station) (Annex 3.4)
The second questionnaire instead refers to the facilitator’s self-evaluation of a specific
facilitation of a single SangSangai station. As a consequence, a separate questionnaire needs
to be filled in for each single station of SangSangai by the respective facilitator. The facilitator shall reflect on his/her facilitation skills, factual knowledge and approach to the target
group. After the completion of the questionnaire, it is handed over to the supervisor.
72 |
Questionnaire 3: Facilitation of SangSangai stations (supervision for each individual
station) (Annex 3.5)
The third questionnaire also refers to the specific facilitation of a single station and has to
be filled in for each single station separately by the supervisor. The supervisor should fill
in the first part (sec. a – i) of the form while observing the event and the second part (sec.
j – k) after he/she has received the self-evaluation and discussed the results with the facilitator in order to document the supervision measures. Afterwards, the questionnaire shall be
signed by the supervisor, coordinator and facilitator jointly.
Supervision of SangSangai implementation
Tools/
Method
Who is in
charge
When
Why
Remarks
Pre- and
post-test
Facilitators give
questionnaires to
the participants,
collect them and
hand them over
to the coordinator
Before and
after each
SangSangai
event
To measure and
compare knowledge of SangSangai participants
before and after
SangSangai
Annex: 3.1:
Event report
The coordinator
completes the
event report
After completion of each
SangSangai
event
To document the
total numbers
(male/female) that
participated as
well as challenges
Annex 3.2:
Progress
report
Focal person of
implementing
agency in Kathmandu
Quarterly
To document the
progress made
and to steer the
implementation
Reporting
format
Supervision
visit
Focal person of
implementing
agency
During SangSangai event,
twice per year
in one district
To provide onsite
coaching to the
facilitators.
Annexes 3.3,
3.4 and 3.5:
Supervision
forms
Pre- and
post-test
questionnaire
Reporting
form for Event
report
| 73
Annexes
Annex 1: Material checklist
Station
Activity
Materials - Quantity
HIV Transmission and Prevention
-
Station floor mat - 1
1.
None
2.
Body fluid droplet pieces - 7
‘INFECTIOUS’ sign - 1
‘NON-INFECTIOUS’ sign - 1
Puzzle pieces - 6
3.
Behaviour pictorial cards - 11
Smiley pieces - 3
Sexual Health
4.
Situation text cards - 3
-
1.
Female reproductive organ - 1
Male reproductive organ piece - 1
Egg piece - 1
Sperm piece - 1
Egg with sperm piece - 1
Menstruation piece -1
Questions cards - 7
2.
Pregnant girl panel - 1
School girl panel - 1
Topic cards - 5
3.
‘TRUE’ panel stand - 1
‘FALSE’ panel stand - 1
Statement cards - 3
74 |
Missing
Station
Activity
Materials
Missing
Contraception and Family Planning
-
1.
Zip bags with contraceptives - 6
Extra zip bag with condom - 1
Information text cards - 7
Statement cards - 6
2.
Condoms - 100
Wooden penis models - 2
Paper handkerchiefs – 100 (optional)
Gender
-
1.
‘SEX’ panel stand - 1
‘GENDER’ panel stand - 1
Statement cards - 6
2.
Pictorial cards - 3
Facilitator’s cards - 3
3.
Pictorial cards - 5
Facilitator’s question card - 3
Sexual and Reproductive Rights
-
1.
Statement cards without examples - 5
Statement cards with examples on the back
(cards for facilitator) - 5
2.
Case study cards - 3
Character picture panels - 3
Facilitator’s cards - 5
3.
Girl puppets - 2
Boy puppet - 1
Doctor puppet - 1
SangSangai Material Bags
Station Bags - 5
Board Bag - 1
Station Floor Mat Bag -1
| 75
Annex 2: Pictures of all materials
HIV Transmission and Prevention
• Station floor mat - 1
Activity 2: Body fluids and HIV prevention
• Body fluid droplet pieces - 7
• ‘INFECTIOUS’ sign - 1
• ‘NON-INFECTIOUS’ sign - 1
• Puzzle pieces - 6
76 |
Activity 3: Risky and non-risky behaviour
• Behaviour pictorial cards - 11
• Smiley pieces - 3
| 77
78 |
Activity 4: “What would you recommend, if a friend told you ...?”
• Situation text cards - 3
| 79
Sexual Health
Activity 1: Puberty and Fertility
• Female reproductive organ - 1
• Male reproductive organ piece - 1
• Egg piece - 1
• Sperm piece - 1
• Egg with sperm piece - 1
• Menstruation piece -1
• Questions cards - 7
80 |
| 81
Activity 2: Consequences of Adolescent Pregnancy
• Pregnant girl panel - 1
• School girl panel - 1
• Topic cards - 5
82 |
Activity 3: Sexual desires and relationships
• ‘TRUE’ panel stand - 1
• ‘FALSE’ panel stand - 1
• Statement cards - 3
| 83
Contraception and Family Planning
Activity 1: Options for contraception
• Zip bags with contraceptives - 6
• Extra zip bag with condom - 1
• Information text cards - 7
84 |
| 85
Activity 2: Condom demonstration
• Condoms - 100
• Wooden penis models - 2
• Paper handkerchiefs – 100 (optional)
86 |
Gender
Activity 1: Difference between sex and gender
• ‘SEX’ panel stand - 1
• ‘GENDER’ panel stand - 1
| 87
88 |
Activity 2: Gender-based division of labour, access to and control over resources
• Pictorial cards - 3
• Facilitator’s cards - 3
| 89
Activity 3: Now and tomorrow: changing gender roles in our Nepali society
• Pictorial cards - 5
90 |
| 91
Sexual and Reproductive Rights
Activity 1: Introduction to sexual and reproductive rights
• Statement cards without examples - 5
• Statement cards with examples on the back (cards for facilitator) - 5
92 |
| 93
94 |
Activity 2: Case studies on sexual and reproductive rights
• Case study cards - 3
• Character picture panels - 3
| 95
96 |
Activity 3: Puppet theatre
• Girl puppets - 2
• Boy puppet - 1
• Doctor puppet - 1
| 97
SangSangai Material Bags
• HIV Transmission and Prevention Bag -1
• Contraception and Family Planning Bag -1
• Gender Bag -1
• Sexual and Reproductive Rights Bag -1
• Sexual Health Bag -2
• Station Floor Mat Bag -1
98 |
(*
Annex 3: Questionnaires
Annex 3.1: Pre- and post-test questionnaire
The information given by you is very important to us and we’ll keep the confidentiality of
the answers you provide. You do not need to write your name in this sheet.
a.
Name of the school/institution:
b.VDC/Municipality:
c.
School grade:
d.
Sex: Male/Female/Others
e.
Marital Status: Married/Unmarried
f.Date:
Please use the
mark in the answer that you think is correct:
Question
1.
Can people reduce the chance of being infected with HIV by correctly using a condom
every time they have sex ?
2.
Can a person be infected with HIV by sharing a
meal/cloth or playing together with someone
who is infected?
3.
Can a person be infected with HIV from
mosquito bites?
4.
Can a person reduce his/her chance of HIV
infection by having sex with just one faithful
partner?
5.
Is it possible that a healthy looking person is
HIV-positive, i.e. infected with HIV?
6.
Only men can decide on when and how many
times his partner should become pregnant.
7.
Preventing an unintended pregnancy is a joint
responsibility of both partners.
8.
Condom is the only contraceptive that has the
dual function of preventing both from becoming pregnant and getting infected with HIV and
most other sexually transmitted infections.
9.
It is the responsibility of women to do household chores like cooking, washing, caring of
baby etc.
Yes
No
I don’t know
| 99
10.
Homosexuality of a person is not acceptable
to me.
11.
It is the right of a man to come home drunk
and beat his wife.
12.
Is a woman allowed to say NO to her partner
if she doesn’t want to have sex?
13.
Is a woman impure during her menstruation
period?
14.
Do I have the right to get contraceptives
although I am an unmarried girl/boy?
15.
When I am homosexual and HIV-infected, do I
have the right to live in the family/community
as other people?
Thank you!
100 |
Annex 3.2: Event Report
Reported by:
District:
Designation:Venue:
Implementing Agency:
Contact person of venue:
Date:Designation:
Telephone number:
Total number of Participants
Total Male: Total Female:
Setting:
Private:
Government:
Others:
Name of school (Please specify which grades were included):
Out of school (give detail):
Issues and challenges:
a. Overall
b. HIV Transmission and Prevention Station
c. Sexual Health Station
| 101
d. Contraception and Family Planning Station
e. Gender Station
f. Sexual and Reproductive Rights Station
Major questions asked today by the participants
SangSangai was implemented
On request by school
On suggestion of DHO/DPHO
On suggestion of implementing agency
Things to bear in mind for next SangSangai event:
102 |
Annex 3.3: Supervision - Questionnaire 1:
Logistics and Management of SangSangai Assignments (event as a whole)
a)Location:
b)Date:
c) Target Group:
d) Number of Participants:
e) Coordinator: f) Supervisor:
g) Facilitators: h) Stations: 1.
/
1.
2.
/
2.
3.
/
3.
4.
/
4.
5.
/
5.
i) Evaluation
Logistics
1
Stations are set up in advance by the
facilitators.
2
The visual materials are correctly
displayed on the stations.
3
All materials are well maintained,
safe and clean.
4
Adequate stock of condoms, water,
booklets, pre- and post-tests, event
report forms are available.
5
SangSangai materials e.g. stations,
materials, e.g. cards, timer and warning bells are in place.
Excellent
Good
Satisfactory
Unsatisfactory
Remarks
Management of SangSangai events
6
Participants are warmly welcomed
by SangSangai coordinator and facilitators.
7
Clear instructions for taking part in
SangSangai are provided.
8
Facilitators are efficient and successful in dividing the group of participants into five sub-groups.
| 103
9
In case guests are present (teachers,
school directors, medical doctors,
media, etc.) they are welcomed and
accompanied by coordinator through
the stations of SangSangai.
10
Planned time schedule is observed.
11
Instructions to direct sub-groups from
one station to the other are clear and
supportive.
12
Pre- and post-test questionnaires are
administered and collected after having been filled by participants.
13
Participants are thanked and SangSangai booklets are distributed by
coordinator and facilitators.
j)
Feedback given by supervisor to SangSangai coordinator:
k) Decisions taken by SangSangai coordinator to improve the logistics and management (if
necessary):
1.
2.
3.
Date:
Signed by
(Supervisor)(Coordinator)
104 |
Facilitation of SangSangai stations (Facilitator self-evaluation of station)
a)Location:
b)Date:
c) Target Group:
g) Facilitators: h) Stations: i) Evaluation
Facilitation Skills
1
Facilitators give a warm
welcome and farewell
to participants at each
station.
2
Clear instructions for
interacting at the station are provided.
3
Probing and bouncing
back questions are appropriately used.
4
Interaction and discussion among participants
takes place.
5
Facilitator keeps eye
contact with the target
group and has a positive
attitude towards them.
6
Cards and materials are
correctly used. The presentation of the station
follows step-by-step
the SangSangai method.
7
Facilitator has good
time management.
Excellent
Good
Satisfactory
Unsatisfactory
Remarks
Facilitation Skills
8
Facilitator gives correct
factual information.
9
The main messages of
the station have become
clear and were underlined by the facilitator.
| 105
Approach to target group
10
Appropriate words/language is used.
11
Facilitators are able to
talk openly about SRHR
issues.
12
Facilitators are respectful and non-judgmental
towards participants
and their opinions.
Date:
Signed by
(Facilitator)
106 |
Facilitation of SangSangai stations (supervision of each individual station)
a)Location:
b)Date:
c) Target Group:
g) Facilitators: h) Station: i) Evaluation
Facilitation Skills
1
Facilitators give a warm
welcome and farewell
to participants at each
station.
2
Clear instructions for
interacting at the station
are provided.
3
Probing and bouncing
back questions are appropriately used.
4
Interaction and discussion among participants
takes place.
5
Facilitator keeps eye
contact with the target
group and has a positive
attitude towards them.
6
Cards and materials are
correctly used. The presentation of the station
follows step-by-step the
SangSangai method.
7
Facilitator has good time
management.
Excellent
Good
Satisfactory
Unsatisfactory
Remarks
Facilitation Skills
8
Facilitator gives correct
factual information.
9
The main messages of
the station have become
clear and were underlined by the facilitator.
| 107
Approach to target group
10
Appropriate words/language is used.
11
Facilitators are able to
talk openly about SRHR
issues.
12
Facilitators are respectful and non-judgmental
towards participants and
their opinions.
j)
Feedback given to facilitator (in the presence of the SangSangai coordinator):
Please tick:
(1) In plenary
(2) In a separate session
k) Decisions taken by the facilitator to improve his/her performance and quality in
facilitation:
1.
2.
3.
Date:
Signed by
(Supervisor)
108 |
(Coordinator)
(Facilitator)
Deutsche Gesellschaft für
Internationale Zusammenarbeit (GIZ) GmbH
Health Sector Support Program (HSSP)
Department of Health Services
Teku, Kathmandu
Nepal
T +977 1 4261404
F +977 1 4261079
E [email protected]
I www.giz.de/nepal
Financed by

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