Written by Dr. Kechi Achebe MD, MPH, Senior Director, HIV/AIDS & TB, Save the Children US
World AIDS Day is held on the 1st December each year and is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died. It is also an opportunity to remind the public and Governments that HIV has not gone away – there is still a vital need to increase awareness/education, access to testing and treatment, as well as fight prejudice.
Globally there are an estimated 36.9 million people living with HIV, as of 2017. 35.4 million people have also died of HIV or AIDS since the start of the epidemic, making it one of the most destructive pandemics in history. While scientific advances have been made in HIV treatment and this is very encouraging, there were still 1.8 million people who became newly infected with HIV in 2017 globally.
More saddening is the impact of HIV on adolescents. Currently, over 30% of all new HIV infections globally are estimated to occur among youth ages 15 to 25 years. Young people (10 to 24 years) and adolescents (10 to 19 years), especially young women and young key populations, continue to be disproportionately affected by HIV. There were 1.8 million children <15 years living with HIV in 2017 globally, while in 2016, 2.1 million people aged between 10 and 19 years were living with HIV and 260,000 became newly infected with the virus. AIDS is now the leading cause of death among young people in Africa and the second leading cause of death among young people worldwide.
As we commemorate the 30th World AIDS Day, Save the Children is making a global call for increased access to HIV prevention education, testing and treatment to adolescents. Save the Children is also joining UNAIDS and the global community to call for increased access to HIV testing and increased uptake of HIV testing, even amongst adolescents. This is to ensure that the 9.4 million people around the world who are unaware of their HIV-positive status can access treatment and that people who are HIV-negative can continue to protect themselves against the virus.
This will renew the possibility of an AIDS-free generation. We need to do more to show adolescents that their lives matter – regardless of their gender, race, sexual orientation, or socioeconomic status.
Written by Nikhit D’Sa, Director of Research, Evaluation, and Learning, Education and Child Protection at Save the Children
The current generation of 1.8 billion young people (aged 10-24) is the largest in our global history. This burgeoning youth cohort is especially evident in sub-Saharan Africa; the 10 youngest nations by population age are in sub-Saran Africa; the median age in five of these countries – Niger, Uganda, Mali, Malawi, and Zambia – is under 16 years, with approximately 60% of the population under the age of 25. Harnessing this demographic dividend has proved difficult. Youth unemployment rates have remained persistently high for the last decade; for every adult of working age who is unemployed, about four youth of working age are also unemployed. In addition, this issue is compounded for youth in rural communities of continental Africa who have never been to school or left school early; gross school enrollment rates are some of the lowest for these youth, while the working poverty rates are some of the highest globally. The issue facing these youth is as much about underemployment and low quality employment as it is about unemployment.
Launched in 2012, Youth in Action (YiA) was a six-year program implemented by Save the Children in partnership with the Mastercard Foundation. The goal of YiA was to improve the socioeconomic status of 40,000 out-of-school youth (12-18 years) in rural Burkina Faso, Egypt, Ethiopia, Malawi, and Uganda. The YiA program aimed to strengthen work readiness skills, then develop business and management capabilities, and create space to apply learned skills, all while supported by family and community. While there is a growing body of research on programming for youth livelihood development, the evidence on the effectiveness of these programs is mixed. Additionally, there are still questions around equity: who benefits from these programs and who is left behind? To address some of these research gaps, Save the Children embedded 32 studies into the six years of implementing YiA. In October 2018, Save the Children launched a report—Supporting rural youth to leverage decent work: Evidence from the cross-sectoral Youth in Action program – that synthesizes the findings from the studies to reflect on four key evidence-based lessons.
Lesson 1: Work readiness is possible in four months
Since YiA focused on vulnerable, out-of-school youth from especially rural areas in each of the five countries, the program prioritized supporting youth to build functional literacy and numeracy, financial literacy, and transferable life skills. YiA youth made significant and practical improvements in nearly all these work readiness skills in Burkina Faso, Egypt, Ethiopia, and Uganda, but not in Malawi. Literacy was the one skill area where youth were still lagging after YiA; less than half the youth in Burkina Faso, Egypt, Ethiopia, and Malawi could read a grade 3 passage with comprehension by the end of the program. One of the issues was that unlike other work readiness skills youth had limited opportunities to practice their literacy foundations after the first four months of dedicated learning. They needed additional literacy instruction with more practical ways to practice their skills in the labor market. Overall, the findings support the YiA hypothesis that youth can build a wide variety of work readiness skills over a condensed time-period – four months of sessions, three sessions/week, and three hours/day. This accelerated programming can be especially effective if coupled with focused and explicit instruction as well as opportunities to engage in practical activities, like saving with a formal institution, that supports future livelihood development.
Lesson 2: Livelihood development IS enhanced by family and community support
In the rural contexts where YiA was implemented, parents and community members are the gatekeepers to the labor market. Youth are negotiating their reputation in their community for being hard working and responsible. One way in which youth can build this reputation is by participating in programs like YiA, providing a signal to family and community that the youth would make a good employee or that support for a youth-run business would pay off. YiA worked on this by engaging early with communities and clearly explaining its value in reliably supporting youth development. Prior to YiA, families and communities were hesitant to provide youth with substantial financial, material, and/or emotional support for livelihood development. In all the countries, YiA youth reported marked increases in support from their family for livelihood development in the form of space for a business, land, tools, and/or emotional support. They also reported improved support from community business mentors at least nine months after graduating from the program. Additionally, increases in family and community support over the program period were associated with stronger gains in work readiness skills like financial literacy and communication.
Lesson 3: Quantitative data can mask gendered barriers
Disaggregating quantitative data by gender is the first step. It gives us a picture on whether there are differences between male and female youth. However, outcomes data may mask important gendered barriers that influence the livelihood development of male and female youth. For example, while male and female youth reported equivalent levels of and gains in family and community financial, emotional and material support in the outcomes data, the qualitative data highlighted that the kind of support often differed by gender. Families often provided female youth more limited financial resources than male youth because female youth were viewed as having a smaller payout since they would leave the home once married. Moreover, parents and community members often felt that the mobility of female youth had to be restricted to ensure their safety, resulting in more support for home-based micro-enterprises as compared to support for a wider range of non-home-based business options for male youth. In some communities, this restriction on the type of micro-enterprise limited the income and savings opportunities for female youth.
Lesson 4: Rural Youth choose and can sustain self-employment
The figure below illustrates the employment status of youth before YiA and at least nine months after graduating (pooled data for Burkina Faso, Egypt, Ethiopia, and Uganda). We found a marked decrease in the percent of youth wage-employed and unemployed, and a statistically and practically significant increase in youth who were self-employed. This is likely because, while YiA started with five pathways, youth in all five countries overwhelmingly chose self-employment and started a micro-enterprise. The decrease in wage-employment may suggest less stability for some youth. However, wage employment before YiA was primarily seasonal and temporary. This is why YiA views the move to sustained self-employment as progress toward decent work for these youth.
While we were not able to disaggregate income and savings information by which pathway youth selected, the fact that a majority of youth selected the self-employment pathway does suggest that improvements in income and savings are heavily influenced by the sustained self-employment of youth. In Egypt, Ethiopia, and Uganda, youth were able to establish work that allowed them to individually move above the USD 1.90/day international poverty line, effectively improving their socioeconomic status. Additionally, across Burkina Faso, Egypt, Ethiopia, and Uganda, 40% of youth reported saving formally or informally before YiA. At least nine months after YiA this increased to 80% of youth, with the average youth reporting an almost fivefold increase in the amount saved.
As we look to build more evidence on holistic skill-building models like YiA, future research should focus on more robust comparison-group prospective studies that follow youth from the start of the program to their socioeconomic development several years after the program. Furthermore, the next round of research needs to move beyond simply disaggregating data by gender. We need to collect reliable and valid mixed methods data on gender norms among youth, in their families, and in their communities. Collecting gender norms data can allow us a more dynamic understanding of the gendered barriers facing male and female youth, and how socioeconomic development varies based on the presence of specific gendered norms.