CARE International began adolescent reproductive health programming in Lusaka, Zambia, in 1996 with the start of the Partnership for Adolescent Sexual and Reproductive Health (PALS) project. This project recognized adolescents as a critical target group for HIV/AIDS awareness programs in a country with a high HIV/AIDS prevalence rate. The project actually began in 1996 as a result of a participatory appraisal in the peri-urban compound of Chawama, conducted by CARE in order to learn more about adolescent reproductive health concerns and needs from the perspective of adolescents themselves. This included documenting their knowledge, attitudes and behavior, and gender and generational relations, as well as identifying barriers to health service utilization. The appraisal raised a number of concerns. For example, it demonstrated that sexual activity among adolescents was widespread, started unusually early, and occurred mostly without the use of any form of contraception. In addition, the appraisal showed that most adolescents lacked information about the types of services available to them at clinics. In fact, services such as family planning and antenatal screening were seen as available only to married adults with children. The appraisal further revealed that many adolescents did not use the reproductive health services at clinics because of the perceived unfriendly attitude of health workers, as well as because of a lack of privacy.
The PALS project was designed to help improve the health and well-being of adolescents in the peri-urban compounds supported by CARE, by creating adolescent-friendly reproductive health and counseling services delivered in and supported through publicsector clinics. To implement the project successfully, CARE decided that it was necessary to first conduct participatory appraisals in the form of Participatory Learning and Action (PLA) techniques1, similar to what had been conducted in the Chawama compound. Because the PLA appraisals were primarily qualitative, a survey was planned to complement and confirm the findings from the PLA techniques used in each of the compounds.
This paper provides a history of the evolution and application of PLA, including its institutionalization within CARE/Zambia, critical reports on its application in adolescent reproductive health programming, using the quantitative survey methodology as a means of comparing findings from the qualitative research and of supplementing information gaps, and potential future directions for PLA.