Original Research Article 377

STAKEHOLDER MAPPING IN THE PROVISION OF

YOUTH-FRIENDLY REPRODUCTIVE HEALTH SERVICE
IN INDONESIA
Antono Suryoputro1, 2, *, Pimonpan Isarabhakdi1, Muthmainnah3
1
Institute for Population and Social Research, Mahidol University, Nakhonpathom, 73170, Thailand
2
Faculty of Public Health, Diponegoro University, Central Java, Indonesia
3
Faculty of Public Health, Airlangga University, Indonesia

ABSTRACT:
Background: Indonesia has made slow progress in identifying reproductive health needs of young people
and in formulating related policy. As a result of political sensitivity, policy dialogues have not yet been
translated into reproductive health programs and services for young people. Existing Youth Reproductive
Health Programs provide mostly basic information on sexuality and reproductive health, but do not
provide services. As a consequence, the reproductive health needs of unmarried youth in Indonesia remain
unfulfilled. This study aims to identify the roles of stakeholders and explore their position and involvement
in the policy formulation and implementation of Youth Friendly Reproductive Health Service (YFRHS) in
Central Java, Indonesia.
Methods: The study used a qualitative approach through in-depth interviews to collect data from the total
of fifteen stakeholders who are related to the provision of youth-friendly reproductive health service in
the city. Stakeholder analysis framework and mapping were employed to identify the roles and
involvement of stakeholders.
Results: Mapping results indicates that among stakeholders related to the provision of YFRHS, the
Regional Planning and Development Board was identified as the most important stakeholder in providing
policy and environmental support and was categorized as a 'savior' because it had supportive attitude,
strong influence and was actively involved in the provision of YFRHS program. The community health
centers that are coupled with a local school were found to be the most important stakeholder in provision
of YFRHS. District health office had position as 'friend' in conducting problem identification, preparation,
implementation and external socialization whilst district office for education and culture was categorized
as an 'observer' in the program preparation, problem identification and implementation of YFRHS. User
stakeholders had position as a ‘friend’ in strategic advocacy, coordination, external socialization and
implementation of YFRHS because they had supportive attitude but did not have authority and were only
passively involved in the implementation of YFRHS.
Conclusion: Given the rigidity of existing policies related to the provision of YFRHS, more intensive advocacy
to related stakeholders should become a higher priority. Such advocacy should promote the Regional
Planning and Development Board as a powerful regional planning board, the community health centers
which are coupled with schools as the main service provider, and in-school adolescents as the primary user.
Synchronizing the existing roles, actively involving stakeholders, and clearly defining roles of each
stakeholder should be continuously performed in order to create an attitude of mutual support in providing
youth-friendly reproductive health service in Indonesia.

Keywords: Stakeholder mapping, Youth, Reproductive health service, Indonesia

DOI: 10.14456/jhr.2016.51 Received: February 2016; Accepted: April 2016

INTRODUCTION and demographic changes, spread of mass media,

Young people in Indonesia are experiencing the
impact of globalization as are their counterparts in * Correspondence to: Antono Suryoputro
other Asian countries. Extreme rapid social, cultural E-mail: [email protected]

Suryoputro A, Isarabhakdi P, Muthmainnah. Stakeholder mapping in the provision of youth-friendly

Cite this article as:
reproductive health service in Indonesia. J Health Res. 2016; 30(6): 377-86. DOI: 10.14456/jhr.2016.51

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economic and political crises, increasing access to mapping of these changes. In it, there is a process to
recreational drugs and alcohol have become the plan, define who plays what role and relationship,
most threatening factors to young people’s lives [1- how to achieve it, and how to keep track of the
3]. These changes, together with urbanization and progress. This mapping is also the best integrated
the spread of information across nations have approach to planning, monitoring and evaluation
increased the risk related to young people’s health. which can be used at the beginning of the program
Augmented interaction of adolescents is associated after the main focus is determined [14-16]. In every
with high risk behaviors such as excessive alcohol policy making process, stakeholder’s commitment
and tobacco consumption, drug use and sexual plays an important role. The commitment of leaders
behavior that can result in unwanted pregnancy and and decision makers in all levels and sectors greatly
sexually transmitted diseases (STD) including HIV influences policy making and the effort to address
and AIDS [1,4-6] organizational issues. These commitments can be
Since 2000, Indonesia has made a slow progress seen from verbal or written statements about their
in identifying reproductive health needs of young support and or agreement toward particular
people and in formulating related policy. However, organizational issues. Furthermore, commitment
their needs for better sexual and reproductive health can also be developed based on how much time,
information and education in schools have been effort, ideas, moral support and even financial
recognized. It is important particularly in light of the support a stakeholder can dedicate to an
growing epidemic of STD and HIV/AIDS in organization. The purposes of stakeholder mapping
Indonesia. Nevertheless, as a result of political are; (1) As a method to map the stakeholders
sensitivity, policy dialogues have not yet been associated with a program or policy, (2) To provide
translated into reproductive health programs and an overview of the factors associated with a program
services for young people [7-10]. Existing youth or policy, (3) Help focus advocacy to each intended
reproductive health (YRH) programs provide stakeholder, and (4) Showing the advantages and
mostly basic information on sexuality and disadvantages of each stakeholder associated with a
reproductive health, but do not provide services. particular program or policy [16,17].
Indeed, the Indonesia Family Welfare Act (UU no This study aims to identify the roles of
10/1992) forbids unmarried young people to access stakeholders and explore their position and
family planning and contraception information and involvement in the policy making process and
services [8, 9]. Additionally, the existing implementation of Youth Friendly Reproductive
Information, Education and Counseling (IEC) Health Service (YFRHS) in Central Java, Indonesia.
programs provide information which is mostly
limited to promotion of traditional family, moral and METHODS
religious norms rather than information on sexual This study employed a qualitative approach by
and reproductive health, including how to avoid collecting detailed information on policies and other
unsafe sex [7, 11, 12]. environmental support systems through in-depth
Although several studies on YRH issues have interviews. The information was collected from key
been done in Central Java, the focus is primarily on informants who involved in YFRHS and related
the demand side of YRH services such as youth institutions such as schools, health offices, and local
sexual behavior, attitudes and knowledge of authorities in Central Java Indonesia. The key
reproductive health and STDs and HIV/AIDS [5, 12, informants in this study were totally fifteen
13] Studies that focus on the supply side and stakeholders who contributed to the implementation
stakeholders’ map of YRH services more need to be of YFRHS program in the city. They were chosen
undertaken to provide a broader and clearer picture purposively in accordance with the YFRHS guide,
on implementation of YRH services in Central Java, where the adolescent reproductive health team
Indonesia. determines the successful implementation of the
Stakeholder mapping is a framework in YFRHS program. Sampling was based on the
program management, which recognizes the adequacy of information on the YFRHS program in
complexity of the social system and the influence or the city, by considering sampling principles of
limitations of the intervention program. The appropriateness and adequacy [18].
orientation of this approach is the behavior change Stakeholders who involved in the YFRHS
of the actors, interaction between actors, and the program were identified and selected as research

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subjects in this study. It consists of ten types of implementation.

stakeholder that were grouped based on their role Stakeholder analysis framework in this study
and function related to provision of youth friendly employed mapping analysis tool approach adopted
reproductive health service, which were; decision from Lusidus Consulting Ltd. [17] and stakeholder
maker and service provider. The results of the classification model from Vos and Achterkamp [14].
stakeholder groupings were as follow: (1) Decision- According to stakeholder mapping model adapted
maker stakeholders, consisted of the Regional from Lucidus Consulting Ltd., there are stakeholder
Planning and Development Board, district health potential categories based on three dimensions,
office, district office for religious affairs, district namely; attitude, power and interest. The extent of
office for education and culture, stakeholders in these dimensions in each stakeholder will determine
district office for social services, youth and sports; their group position categories [20] as explained
(2) Service provider stakeholders, consisted of 5 bellow:
community health centers and teachers who in Savior is addressed to those who have
charge in adolescent reproductive health education supportive attitude, strong influence and active
(5 guidance and counseling teachers of schools in involvement. The parties will do whatever is
the community health centers coverage area). necessary to maintain their alignment, as well as pay
In-depth interviews were employed to collect attention to their needs.
qualitative information from selected stakeholders Sleeping giant are those who have supportive
by appointments. The collected information from attitude, strong influence but passive involvement.
the in-depth interview was recorded and transcribed They need to be included in the process in order to
and the data was then grouped and analyzed by be awakened.
applying the content analysis method [19]. Friend refers to those who have supportive
Ethical clearance of this study was obtained attitude, weak influence but active involvement.
from Commission on Health Research Ethics, They should be positioned as a confidant or adviser.
Faculty of Public Health, Diponegoro University Observer usually has supportive attitude, weak
(no 246/EC/FKM/2013, dated 21 October 2013) influence and passive involvement. This group of
prior to data collection. stakeholders needs to be kept in touch and
Steps of qualitative data analysis were as continuously be given information [17, 20].
follows: Among those in non-supportive group,
1. Characteristics of stakeholder - stakeholder saboteurs are those with non-supportive attitude,
identity including; age, level of education, occupation, strong influence and active involvement, whilst trap
length of employment, organization’s origin. is given to those who have non-supportive attitude,
2. Stakeholder power - perception of weak influence and passive involvement. They need
stakeholders in influencing YFRHS program to be understood, so that they can be cautiously
implementation. Influence is indicated in categories; approached. Irritants are those who have non-
‘strong’ and ‘weak’. supportive attitude, weak influence but active
3. Stakeholder attitude - perception of involvement, and time-bomb refers to a group of
stakeholders in supporting YFRHS program stakeholders with non-supportive attitude, strong
implementation. Attitude is indicated in categories; influence and passive involvement [17, 20]
‘supportive’ for positive attitude and ‘non The result of stakeholder’s analysis was a map
supportive’ for negative attitudes. of various position stakeholders in providing youth
4. Stakeholder interest - perception of friendly reproductive health services in the city.
stakeholders to engage in the YFRHS program
implementation. Interest is indicated in categories; RESULTS
‘active’ for those who are willing to engage and Characteristics of stakeholder
‘passive’ to those who are unwilling or reluctant to Majority of informants in this category
engage. (decision maker stakeholder) hold a master’s degree,
5. Stakeholder mapping - analyzing attitude, all of them were male with age range of 40 to 52
influence, and involvement of each stakeholder years old, and works as head of sections/division
(decision maker, provider, and user) relating to the which were related to the provision of YFRHS and
function and role in the YFHS program program in the city.

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Table 1 Mapping of decision maker stakeholders in YFRHS

Planning & policy Reporting, recording

Stakeholder Implementation
advocacy and evaluation
Regional Planning and Attitude +
Development Board Power +
Involvement +
SAVIOR
District health office Attitude + + +
Power - - -
Involvement - - -
OBSERVER OBSERVER OBSERVER
District office for education & Attitude + + +
culture
Power + + -
Involvement + + -
SAVIOR SAVIOR SAVIOR
District office for social youth Attitude + + +
sport 1
Power - - +
Involvement - + -
SAVIOR FRIEND Sleeping giant
District office religion affair Attitude + + +
Power - - -
Involvement - + -
OBSERVER FRIEND OBSERVER
Attitude: (+) Supportive attitude, (-) Not supportive
Power: (+) Strong power/influence, (-) Weak power/influence
Involvement: (+) Actively involve (has strong interest), (-) Passively involve (has no interest)

Other informants were service provider (decision maker) stakeholders were categorized as a
stakeholders who directly in charge in providing ‘savior’, ‘observer’ and ‘friend’ in the provision of
services for youth both inside and outside of health YFRHS and program in the city.
centers. All providers (10 informants) in community Regional Planning and Development Board was
health centers (YFRHS program officers) and categorized as a ‘savior’ because it had supportive
school (guidance and counseling teachers) were attitude, strong influence and was actively involved
college educated with age range between 27 to 54 in the provision of YFRHS and program, which
years old, and most of them were female (73.34%). includes activities such as problem identification,
public policy advocacy, integration, collaboration
Stakeholder mapping based on stakeholder
and coordination. Regional Planning and
perception on their influence/power, attitude and
Development Board had a strong influence in
involvement/interest in YFRHS and program
determining the program planning of each decision-
Decision maker-stakeholder making stakeholder who had adolescent health
As described in Table 1, decision maker related program and also has being actively involved
stakeholders in this study consists of five in the public policy advocacy. In this case, it’s task
government institutions in the city, including was to facilitate coordination with all stakeholders
Regional Development and Planning Board, district of adolescent health related programs in order to
health office, district office for education and avoid overlapping among similar adolescent
culture, district office for social youth sport, and programs in the city. This can be explained by the
district office for religion affair. The result indicates statement below:
that the decision maker group generally had a strong
support to the provision of the YFRHS and program “...Regional Planning and Development
in the city. However, when classified into their Board takes care of the macro planning, but
degree of support, the difference among the technical implementation is distributed to
stakeholders occurs. Majority of policy makers each regional government unit, our job is to

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evaluate whether the programs of each unit “...We have a monthly coordination meeting
is in accordance with the city’s MDG to discuss about the healthy schools
strategic planning. So the units strategic program...”
planning must refer to the regional master
plan, to achieve 2015 MDGs …... “ The statements above shows that the
implementation of health programs in schools is
District/city health office is the leading carried out by the Ministry of Education and Culture
institution in the initiation and implementation of in cooperation with other institutions such as
YFRHS. Results of the mapping analysis indicates Ministry of Health and Ministry of Religious
that position of district health office as a ‘savior’ in Affairs. District office for education and culture was
the provision of YFRHS activities such as planning, categorized as an ‘observer’ in the YFRHS
public policy advocacy, collaboration and preparation, problem identification, implementation
coordination, monitoring and evaluation, and data and data recording and reporting. The office fully
recording & reporting. District/city health office had delegates schools in the city to implement their own
supportive attitude, strong influence and active school health program based upon each school's
involvement in conducting public policy advocacy. ability.
Public policy advocacy is the district health office’s The social service section of district office for
effort to influence relevant stakeholders for the social youth and sport was classified as a ‘friend’ in
implementation and sustainability of the adolescent the provision of YFRHS. It means that the
health programs. Therefore, district health office section/division has a supportive attitude, weak
also had a strong influence and was actively influence and passive involvement in the program.
involved in conducting inter-sector cooperation. This section/division mainly serves to enhance
In addition, district health office had position as youth skills through many workshop and trainings.
‘friend’ in conducting problem identification, They believed that adolescent health programs
YFRHS preparation, implementation and external become the responsibility of schools and the district
socialization. It suggests that district health office health office.
had weak influence and passive involvement. It The last decision maker stakeholder is district
delegates the tasks to the YFRHS program officers office for religion affair. Its position was as a
in community health center in the implementation of ‘friend’ in conducting the problem identification,
YFRHS and program ranging from planning, advocacy, implementation, monitoring and evaluation
monitoring and evaluation to socialization. and data recording and reporting. Please refer to the
The next decision maker stakeholder is district following statement:
office for education and culture, which was
classified as a ‘savior’ in carrying out advocacy, “...It is actually needed but we don’t have the
coordination and monitoring and evaluation. The budget, so we usually only follow the central
role of district office for education and culture was government program, even if there is a
very important in provision of adolescent health program in the research development section
programs in schools, as shown by the following that focuses on Islamic education...”
statements:
“...Programs like that are supposed to be
“...We don’t have much knowledge and known by everyone, too bad we don’t have a
resources in the health sector so we must specific health program. If there is an
partner up with the district health office to invitation from social welfare we’re always
conduct the healthy schools program. proactive...”
District health office helps us educate health
information and related issues to schools The statement indicates that the district office
students and teachers...” for religion affair had a supportive attitude in the
implementation of YFRHS programs. It supports
“...The school health unit program is a joint YFRH programs but has weak authority, and passive
decree, we share the responsibility with involvement. Furthermore, district office for religion
district health office, social welfare, district affair had no specific adolescent health programs
office for religious affairs...” due to budget and human resources limitations.

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Table 2 Mapping of provider stakeholders in YFRHS

Planning & policy Reporting, recording

Stakeholder Implementation
advocacy and evaluation
Community health center 1 Attitude - + +
Power - + -
Involvement - + -
TRAP SAVIOR SAVIOR
Community health center 2 Attitude - + +
Power + + +
Involvement - + +
TRAP SAVIOR SAVIOR
Community health center 3 Attitude - + +
Power - + -
Involvement - + -
TRAP SAVIOR OBSERVER
School 1 Attitude + + +
Power + + -
Involvement + + +
SAVIOR SAVIOR FRIEND
School 2 Attitude + + +
Power + + +
Involvement + + +
SAVIOR SAVIOR SAVIOR
School 3 Attitude + + +
Power - - -
Involvement - -
OBSERVER OBSERVER OBSERVER

Attitude: (+) Supportive attitude, (-) Not supportive

Power: (+) Strong power/influence, (-) Weak power/influence
Involvement: (+) Actively involve (has strong interest), (-) Passively involve (has no interest)

Service provider stakeholder been decided that we can’t conduct direct

The majority of stakeholders in this group were survey to teenagers since they will not be
classified as ‘savior’. As illustrated in Table 2, most very open to adults, because they are scared
of the informants in this stakeholder group support of being judged by adults...” Community
have influence and was actively involved in the health center 1
implementation of YFRHS strategic measures.
Community health center is a stakeholder which “...If we conduct everything we won’t have
plays an important role in the implementation of the energy and resources left. If we carry out
YFRHS program. Community health center is surveys before the activities to figure out
subordinate of the district health office, providing what the teenagers need, we do not have
health service needed by community including enough time...” Community health center 3
youth both inside and outside of the health center.
Finding indicates that community health center The above statements indicate that most of
was classified as ‘savior’ in YFRHS program community health center did not support, did not
implementation. It supports, has strong influence have authority and had passive involvement in
and is actively involved in the implementation of carrying out the identification of adolescent health
YFRHS. However, in problem identification aspect, issues. In addition, finding also points out the role of
only one community health center was positioned as problem identification was mainly conducted by the
'savior', while the others had position as a ‘trap’. district health office. Community health centers only
This can be shown from the interview as follows: conduct activities based on what district health
office orders. On the other hand, all community
“...We are equipped by the district health health centers supported, had strong influence and
office to provide health services, so it has were actively involved in implementing public

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policy advocacy, coordination, program adolescents). According to Vos and Achterkamp

implementation, and monitoring and evaluation [14], stakeholder mapping is an approach developed
activities. However they still face some obstacles in to overcome the fundamental issues related to the
its implementation due to limited human resources, reporting of development impact. Complexity and
overlapping tasks among health officers, facilities flexibility of a development process means that in
and infrastructure limitations. Other aspects order to achieve “impact” it requires the involvement
including budget constraints, service procedures that of various parties, and often takes place during a
were not yet adjusted to the characteristics of long period of time [21, 22]. Large-scale changes are
adolescents and not all officers are YFRHS trained often the result of a collection of events, over which
were also identified as some obstacles in providing no single institution has full control, nor can they
YFRHS and program. Additionally, conducting data acknowledge themselves as the sole merit. In this
collection or implementation of YFRHS activities way, we can identify by mapping one of the factors
outside the community health center building also or parties as the party who has the strongest
faces a lot of obstacles such as limited human influence to the impact of development.
resources and different understanding about The results of the stakeholder mapping illustrate
collected data between community health centers. the diversity of their commitment and support
Schools are one of the community health center toward provision of YFRHS. It indicates that most
networks in implementing YFRHS in schools. of the stakeholders in the city tend to be classified as
Supervision of community health center to school is ‘savior’ in the provision of the YFRHS program,
necessary to achieve good youth health through whereby ‘savior’ is the stakeholder’s positive
School health unit, networking, socialization/ support attitude, has strong influence and is willing
education, and reproductive health education in to be actively involved. Therefore, special attention
extracurricular or extracurricular programs. In this should be given to them for maintaining their
study, the selected informants were guidance and supportive attitude.
counseling teachers who were specifically appointed Decision-maker stakeholder group provides
by the community health center to coach the School strong support and strong influence to the provision
Health Unit program in school. The finding suggests of YFRHS in the city. Among them, the Regional
that schools were classified as a 'savior' in Planning and Development Board, the district health
conducting problem identification, coordination, office and district office for education and culture
and implementation of YFRHS in schools. were given the position of ‘savior’. However, since
Reproductive health related information in schools Regional Planning and Development Board is a
were delivered by teachers on guidance and planning board of the city, its role in implementation
counseling, biology and religion. Surprisingly, most of YFRHS is limited. The board is involved mainly
of the teachers were not familiar with the term in providing policy and regulation support toward
“youth friendly reproductive health service”. Even the development of youth health-related programs
the guidance and counseling teachers did not know by stakeholders in the city. Furthermore, Regional
that community health centers provide information Planning and Development Board has a very
services, counseling services and training of peer strategic role in the implementation of a program in
educators. Reproductive health information at terms of planning and resource allocation, which
schools are usually delivered through guidance and gives the board a legitimate power and authority to
counseling, biology and religion teachers as well as control and distribute available resources to relevant
through extracurricular activities, seminars, or parties. On the other hand, the district office for
counseling given by academics, community health religion affair and district office for social youth and
centers and non-government organizations. sport are associated with negative attitudes and
passive involvement in the provision of YFRHS The
DISCUSSION finding has similar result with other stakeholder
The results of the stakeholder classification analysis studies in the region which indicates that
indicate that the successful development of a Planning Boards and other government institutions
YFRHS program in the city would depend on had significant roles in better targeting and increase
several important players including the government budgetary allocation for prioritized programs [15,
as decision-maker, program implementers (schools, 16, 23]. Therefore, in order to assure the provision
community health centers), and clients (school of YFRH service, more intensive advocacy to

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Regional Planning and Development Board need to influence the decision makers, which may relate to
be maintained to gain budget allocation and other the variety of stakeholders involved, such as
resources supports. In this study, the stakeholders political and social pressures, economic conditions,
are institutions that already have youth-related procedural requirements, prior commitments, lack
health programs, thus making it easier for them to of time and other factors. Various studies in the
achieve a common goal. However, finding of this Asian countries include China, Malaysia, Myanmar
study indicates the existence of insensitivity. Each and Thailand demonstrated different impacts of
of the stakeholders seems concentrated only on their external situation to the policy makers in their
own programs even when the targets are similar, decision making. Political factor was found to has a
indicating a failure in integrating related youth significant impact in providing health services in
programs and services. Finding also indicates the Myanmar and Malaysia [5, 26, 27], on the other
absence of a clear role distribution among providers hand, social pressure was the main external
as each stakeholder still maintains their own influence in providing sexual and reproductive
programs. Such situation exists perhaps because of related services for youth in other counties [5, 26,
the existence of many government programs relating 28] .
to adolescent health [1, 21, 22, 24, 25]. For instance, The school is one of the community health
the district health office and district office for center’s partners in the implementation of YFRHS
education and culture are potential stakeholders in in school. It provides health-related programs and
the implementation of the YFRHS program. Each of services for adolescents in school through the school
them has youth health programs and are always health unit which is administered by school teachers
actively involved in the coordination of activities. under supervision from community health center.
Furthermore, finding also indicates lack of School health unit’s activities mainly focus on
inter-program cooperation and integration due to the behavior change of adolescents, including sexual
lack of transparency of budget allocation for each and reproductive health behavior, by providing
program. Therefore, a key stakeholder who has information and counseling services. However,
strong power and influence is needed to unite all since many of schools experience lack of trained
existing youth health programs. In this case, local teachers, such activities are not properly carried out.
government should involve every related Therefore, more intensive involvement of
stakeholder and community in the coordination community health centers is needed to guide the
process in order to achieve a common agenda. The schools in carrying out such activities. Strong
government should approach the various relevant partnerships between community health center and
stakeholders to participate and interact with each school should be established with support from local
other to establish an integrated program in government. In addition, the provider stakeholder
promoting youth health [16, 22]. of the YFRHS program in the city comprises
In addition, government institutions should be different professional backgrounds and different
intensively involved in the formulation or work focuses. This situation might affect
development of a public policy as well. This is implementation of YFRHS, and needs solid
related to the understanding that a policy is integration of providers in delivering services. Thus,
something that is usually formulated by the a mutually-supportive attitude and interaction
government in order to address certain issues and, between stakeholders should be strongly encouraged
therefore, the involvement of government officials in implementation of YFRHS, so that their
may help determine the likelihood that a given willingness to share information, conduct problem-
policy is approved [15, 16]. In this case, government solving and combine their respective powers could
institutions have become an important factor in the be performed. As demonstrated from some studies
policy-making process. Furthermore, the process of in South East Asian countries, policy maker support
formulating a policy needs the involvement of every is essential in providing services and implementing
party, whether officially or unofficially. Hence, the programs [15, 21, 29]. For instance, counseling
most important thing is to understand the services through hotline telephone service to reduce
characteristic of each party, their roles, the authority the sexual and reproductive health vulnerability
or power that they have, and how they relate and among Thai’s adolescents, needs policy makers
monitor each other. Anderson, Lindblom, Lester and special support [23, 27]. A study among young
Steward [20] explained that many factors can urban Myanmar also indicated a need of policy

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maker support to develop comprehensive sex the research, and for their comments that greatly
education program [28]. Therefore, stakeholder improved the manuscript.
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