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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. and Obasi, Angela ORCID: https://orcid.org/0000-0001-6801-8889 (2011) '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.'. Journal of Adolescent Health, Vol 48, Issue 1, pp. 79-86.

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Abstract

PURPOSE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Item Type: Article
Uncontrolled Keywords: Adolescents; Scaling up; School based interventions; Sexual and reproductive health
Subjects: WA Public Health > Preventive Medicine > WA 108 Preventive health services. Preventive medicine. Travel Medicine.
WJ Urogenital System > WJ 20 Research (General)
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 320 Urogenital system
WS Pediatrics > By Age Groups > WS 460 Adolescence (General)
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI): https://doi.org/10.1016/j.jadohealth.2010.05.007
Depositing User: Helen Rigby
Date Deposited: 27 Apr 2011 11:37
Last Modified: 09 Nov 2019 10:59
URI: https://archive.lstmed.ac.uk/id/eprint/1791

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