The Ankoay approach includes some 25 activities that employ experiential learning techniques to build young people's capacities to develop life skills such as in communication, forming relationships, and learning how to resist peer pressure, as well as to acquire values concerning gender equity.

Specifically, groups or clubs of young people work through a series of highly participatory life skills activities. An activity guide is the central component of a kit which also includes a skit scenario booklet, an individual reflection tool called the "Youth Passport", and participatory monitoring forms. This combination of materials speaks to a variety of learning styles and personality types. The activity book promotes the development of positive social norms and skills, while the role plays focus on behaviour change through role modeling. The youth passport in turn works through individual introspection leading to personalisation of the issues. Together these materials and approaches are designed to allow youth to "experience" difficult high-risk situations in a safe environment and then "proclaim" their values to the larger community through outreach activities.

The Ankoay model emphasises enthusiasm and action as key to learning. Recognising that behaviour change cannot happen in a vacuum, the model encourages young people to engage their parents, peers, and community in the learning process. Ankoay also taps into the peer dynamics of a cohesive youth club, school, or sports team. Public recognition as part of an "Ankoay Team" through a community-wide celebration of success is an important step in strengthening collective efficacy - the notion by members of a youth group that they can make a difference.

Ankoay launched the "Red Card" (or Aok' Aloha) initiative in October 2006. Women in every region of the country are using the Red Card, a simple, low-cost, scalable tool with the message Aok' Aloha message (meaning either "let's talk - wait, I need time to think," or "back off", depending on the situation in which it is used).

Starting in August 2007, expansion of the Ankoay programme focused on working through smaller non-governmental organisations (NGOs) in urban "hotspots" (one of the six cities in Madagascar with the highest HIV infection rates) with the goal of engaging a greater percentage of high-risk youth. The Ankoay Doré programme is intended for those groups that have already earned the distinction of being Ankoay. The level II programme has the following elements:

•  Broader involvement of youth in community development and peer mentoring - Groups are asked to increase their commitment to community engagement, not only in the areas of HIV and AIDS prevention and control, but also water, sanitation, and hygiene, environmental education, and ARH/family planning (FP). In addition, youth organise group-level activities and perform educational skits to model new behaviours for the community. Each participant in the Ankoay Doré programme is encouraged to mentor ten peers or family members.
• Creation of a dynamic mix of individual and collective efficacy - The programme is constructed on the hypothesis that HIV- and AIDS-related skills will affect mainly individual or self-efficacy, whereas environmental protection activities will bring greater changes in the area of collective efficacy.
• Recognition of success - As compared to the level I (Ankoay) component, the certification process is strengthened, and the public recognition and status accorded youth organisations and groups is expanded (Ankoay Doré places greater emphasis on youth groups as emerging leaders in behaviour change and community development).

Specifically, the Ankoay Doré process revolves around:

• Badges: To earn the hygiene badge, participants learn about water conservation and sterilisation, hygiene practices such as hand-washing with soap, and sanitation issues including utilisation of latrines. For the environment badge, youth engage in activities around management of waste and recycling and learn about the damage caused by deforestation. Groups plant vegetable gardens, visit ecological sites, and are taught the importance of reforestation and energy conservation. The RH/FP badge involves community outreach and distribution of Red Cards, activities around understanding sexuality and puberty, knowledge of abstinence, and avoiding early pregnancy.
• Commitment letter: This initial step involves presenting the Ankoay Doré approach to the participants (groups, instructors, authorities, partners) and clarifying any aspects of the programme that are not clear. Signing the commitment letter is required before a group can send participants to a training workshop.
• Training of Trainers (TOT): To launch a youth group in the Ankoay Doré programme, six participants must attend a two-day skill-building workshop. The agenda focuses on transferring skills linked to the new hygiene, ARH/FP, and environmental badges and includes sessions designed to create greater commitment among youth to community service.
• Month 1 follow-up: Each youth group that has launched activities following a training workshop participates in a monitoring session that serves to measure progress and solve problems encountered since start-up.
• Mid-term monitoring: Trainers visit the youth groups every two months to assist with any difficulties, answer questions, and share successful experiences from other youth groups. Trainers send quarterly activity progress reports against set objectives.
• Evaluation and certification: When a youth group has met the goals of the Ankoay Doré programme, it carries out an internal participatory evaluation. If the group feels they are ready for certification, they contact a local evaluation committee (instructors, parents, health workers, partners, authorities, journalists, etc.) to carry out an official certification. The evaluation is viewed as a learning process. If in fact a youth group is not ready to be certified, the local committee works with the group to develop a plan to complete the remaining goals.
• Celebration of success: Once a youth group has been certified as Ankoay Doré, it organises a festival with the larger community to celebrate the achievement. Festivals are opportunities for groups to show off their talents and skills in areas such as peer education, village theatre, and musical presentation. Neighbouring communities and local media are invited to the festivals. As the programme progressed, the managers of the Ankoay programme systematically invited the testing unit of the CNLS to participate in each festival. Since HIV testing is not associated with significant stigma in Madagascar, at each event dozens of youth and community members line up to be tested.
• The programme anticipates that when a youth group is publicly recognised as a community leader, its sense of collective efficacy will increase and its members will, in turn, demonstrate greater confidence when organising community-based activities. To that end, dozens of groups have organised mini-festivals, half-day development fairs, and celebrations that focus on ARH (including HIV and AIDS prevention games), demonstrations of water purification and correct hand washing, and skits that highlight steps to protect the environment, such as alternatives to slash and burn farming and the importance of recycling.

Youth, Reproductive Health, HIV/AIDS, Environment.

Organisers explain that many of the most important international environmental agencies are active in Madagascar because of its rich biodiversity. Since the birth rate is as high as 6.9 in environmental "hotspots", several organisations have concluded that unless the rate declines their efforts to protect the environment will be offset by population growth. The Malagasy population is approaching 20 million, 16.6% of whom are between the ages of 15 to 24. According to Population Services International (PSI)'s 2003 Tracking Results Continuously (TRAC) survey, for people aged 15-24: 54.2% have had sexual relations; 1.8% have adopted secondary abstinence; 41.8% have been faithful in the last 12 months; and 65.2% believe that HIV/AIDS can be avoided by being careful in choosing one's sexual partners.

In early March 2009, C-Change signed a 4-year Associate Award for "A Cross-Cutting and Comprehensive Behavior Change Communication Program" in Madagascar, with a launch planned during the second quarter of 2009. The additional funding from USAID/Madagascar will assure the sustainability of the Ankoay and Ankoay Doré programmes through September 2013. The C-Change Associate Award outlines approaches for continued collaboration with environmental programmes, with a focus on expanding the programme into more environmentally sensitive regions. C-Change also plans to carry out a formal quantitative and qualitative evaluation of the Ankoay model in 2010.