Scaling up adolescent sexual and reproductive health interventions through existing government systems? a detailed process evaluation of a school-based intervention in Mwanza region in the northwest of Tanzania
Renju, J.R.; Andrew, B.; Medard, L.; Kishamawe, C.; Kimaryo, M.; Changalucha, J.; Obasi, A.
Journal of Adolescent Health Official Publication of the Society for Adolescent Medicine 48(1): 79-86
2011
ISSN/ISBN: 1879-1972 PMID: 21185528 DOI: 10.1016/j.jadohealth.2010.05.007Document Number: 214787
There is little evidence from the developing world of the effect of scale-up on model adolescent sexual and reproductive health (ASRH) programmes. In this article, we document the effect of scaling up a school-based intervention (MEMA kwa Vijana) from 62 to 649 schools on the coverage and quality of implementation. Observations of 1,111 students' exercise books, 11 ASRH sessions, and 19 peer-assistant role plays were supplemented with interviews with 47 ASRH-trained teachers, to assess the coverage and quality of ASRH sessions in schools. Despite various modifications, the 10-fold scale-up achieved high coverage. A total of 89% (989) of exercise books contained some MEMA kwa Vijana 2 notes. Teachers were enthusiastic and interacted well with students. Students enjoyed the sessions and scripted role plays strengthened participation. Coverage of the biological topics was higher than the psycho-social sessions. The scale-up was facilitated by the structured nature of the intervention and the examined status of some topics. However, delays in the training, teacher turnover, and a lack of incentive for teaching additional activities were barriers to implementation. High coverage of participatory school-based reproductive health interventions can be maintained during scale-up. However, this is likely to be associated with significant changes in programme content and delivery. A greater emphasis should be placed on improving teachers' capacity to teach more complex-skills-related activities. Future intervention scale-up should also include an increased level of supervision and may be strengthened by underpinning from national level directives and inclusion of behavioral topics in national examinations.
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