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Randomized Controlled Trial
. 2024 Dec 18;21(1):191.
doi: 10.1186/s12978-024-01920-z.

Lessons from an intervention study on the sustainability of after-school comprehensive sexuality education in Zambia: the perspectives of teachers, health workers and guardians

Joar Svanemyr  1   2 , Joseph Mumba Zulu  3 , Ecloss Munsaka  4 , Ingvild Fossgard Sandøy  5   6
Affiliations
Randomized Controlled Trial

Lessons from an intervention study on the sustainability of after-school comprehensive sexuality education in Zambia: the perspectives of teachers, health workers and guardians

Joar Svanemyr et al. Reprod Health. .

Abstract

Background: Comprehensive sexuality education (CSE) has been introduced in many sub-Saharan African countries, but limited political interest and insufficient funding have resulted in many CSE initiatives being dependent on donor funding or non-governmental organisations (NGOs) supporting its implementation. This has created concerns about the sustainability of the programmes. The objective of this study was to explore factors affecting the sustainability of CSE delivered through a youth club organized after school hours in Zambia.

Methods: We interviewed teachers and community health workers (CHWs) who had implemented CSE as part of an after-school youth club set up as part of a cluster randomized controlled trial. The trial evaluated the effectiveness of economic support for adolescent girls, CSE and community dialogue meetings on adolescent childbearing. Teachers and CHWs in 63 schools were trained to facilitate the CSE youth clubs, and they were given economic incentives during the trial´s two-year intervention period to organize meetings every fortnight. Two years after the external support for the youth clubs ended, we conducted qualitative interviews with the facilitators in 15 of the 63 schools, interviews with some head teachers, and focus group discussions with guardians of adolescent girls.

Results: Whereas CHWs were generally supportive of teaching adolescents about contraception, some of the teachers stressed that abstinence was the most effective method to avoid pregnancy and diseases. The respondents' diverging points of view did not affect their willingness to continue teaching CSE, including contraception. However, the youth club meetings were only continued in a few schools after the external support period ended. This was attributed to transfers of trained teachers and a lack of training among the remaining staff; lapse of moral support, resources and incentives; limited involvement of the school management in the CSE initiative; and attention shifting to other projects.

Conclusion: To ensure the sustainability of CSE initiatives for adolescents, emphasis should be placed on training several teachers in each school, and continued moral support and encouragement also appeared essential.

Trial registration: ISRCTN (ISRCTN12727868).

Keywords: Adolescent sexual and reproductive health; Africa; Comprehensive sexuality education; Sustainability; Youth.

Plain language summary

This study looked at the sustainability of Comprehensive Sexuality Education (CSE) in Zambia, delivered through after-school youth clubs. These clubs were part of a larger project that also provided economic support to adolescent girls and organized community meetings.The clubs were run by a teacher and a community health worker (CHW), who were trained and given financial incentives to hold meetings every two weeks. Two years after the project ended, interviews were conducted with various stakeholders.While CHWs were generally in favor of teaching about contraception, some teachers emphasized abstinence as the best way to avoid pregnancy and diseases. Despite these differing views, all were willing to continue teaching CSE, including contraception. However, only a few schools continued the youth club meetings after the project ended. This was due to trained teachers being transferred, lack of training for remaining staff, loss of support and resources, limited school management involvement in the CSE initiative, and the need to focus on other projects. To ensure the sustainability of CSE initiatives, more teachers in each school should be trained, and continued support and encouragement should be provided.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All the informants provided informed consent to participate in the study. Ethical clearance for RISE and embedded studies was obtained from the University of Zambia Biomedical Research Ethics Committee (ref no 021–06–15) and the Regional Ethics Committee of Western Norway (ref no 2015/895) in 2015 before the start of the trial. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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