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Summary - Linking JIC (Join in Circuits) and Youth Friendly Services - Choma & Livingstone Region

Combining preventive health care information and services in the school environment in Choma and Livingstone
Background and flagship project description

Zambia has seen a significant decrease in the number of new HIV infections since the launch of the first National Strategic AIDS Plan. However, adolescent girls of 15 to 19 years old continue to be disproportionally affected by HIV and unwanted teenage pregnancies.[1] Statistics show that 58.9% of young women between 15 and 19 already had given birth or are pregnant with their first child.[2] Furthermore, only 44.5% of young people between 15 and 24 have comprehensive knowledge of HIV.

The National AIDS Strategic Framework (NASF) 2017–2021 indicates that early sexual debut is one of the key factors that impact HIV transmission. Age-appropriate awareness-raising about the prevention of HIV, sexually transmitted infections (STIs) and unwanted pregnancy enables young people to make informed decisions and protect their health. Comprehensive sexuality education (CSE) has proven to be an important factor in reducing new HIV infection rates and teenage pregnancies among young people. Zambia was one of the first countries in the Eastern and Southern African (ESA) Region to initiate a comprehensive nationwide expansion of CSE programmes. Although CSE is incorporated into the school curriculum, teacher capacity and cultural and social perceptions present challenges. The Ministry of General Education in Zambia, in cooperation with the GIZ ESA Regional Programme (ESA RP) and United Nations partners, has taken steps to improve the delivery of CSE in schools through capacity development of teachers.

Once young people have received adequate information and have been motivated to take up health services, they should have easy access to appropriate, quality and youth-friendly services. However, appropriate health services for young people are often hard to reach and far from schools. Moreover, young people often neglect taking up services because clinics do not cater for the youth, and young people lack confidence, and fear stigma and discrimination.

It is against this background that the ESA RP collaborated with the Multisectoral HIV Programme Zambia and several Zambian implementing partner organisations. In alignment with the NASF 2017–2021, a demand-supply approach was developed in two selected districts in the Southern Province to strengthen the link between sexuality education and access to youth-friendly health services within the school context. The Join-in-Circuit (JIC) was used as a once-off tool to involve learners in a fun and interactive way on the prevention of HIV, and on health care around sexual and reproductive health and rights (SRHR). The implementing partners provided services, including information and activities on SRH.

Results

This flagship project has improved access to SRH information and services for learners at a total number of 101 schools. Mobile service provision in the school environment has proven to be a good approach to motivate learners to take up services. A total number of 1 871 learners took up services; this is 106 more than the 1 765 learners who took part in the JIC. A total of 1 464 learners got tested for HIV and collected their results. This is an outcome return of 83%. Of these, 49% were girls and 51% were boys. The majority of the participants, slightly over 80%, were 15 to 19 years old. The remainder of the learners – 17% of the girls and 18% of the boys – was aged 10 to 14 years. As the age of consent for HIV testing is 16 years in Zambia, these learners were accompanied by their parents. This was a result of the sensitisation efforts conducted in advance in learners’ support environment, including parents and teachers. Through information given on the available services and through referral, this project has further contributed to learners accessing appropriate health services beyond the scope of this project.

Approach and process

The demand-supply approach of this flagship project has strenghthened learners’ access to health care through a combination of SRH sensitisation activities and youth-friendly health care provision. Because of a lack of sufficient good-quality, age-appropriate and continuous CSE activities, SRH awareness-raising through the JIC was used as a once-off method to reach young people. The JIC engages learners in a fun and interactive way. Guided by a trained facilitator, young people walk around the stations, discussing each topic with the facilitator and their peers. Each station has a specific topic, including “STI transmission” or “positive living”. A total of 101 schools took part in the flagship project in the districts of Choma and Livingstone in the Southern Province. The main criteria for selecting these pilot districts were high teenage pregnancy rates and HIV infection rates among youth. The JIC was facilitated among grade 6, grade 8 and grade 9 girls and boys within the age groups 10–14 and 15–19. The ESA RP entered into local subsidy contracts with the four implementing partners (PPAZ Livingstone, NZP+, Mboole, BICC Choma) for the provision of health information and services. These services included STI screening, family planning and HIV counselling and testing (HCT). Health care providers engaged the learners in promotional talks and awareness-raising activities. The learners were given information on the available nearby clinics and in cases where a referral was necessary, they were referred to the next clinic or health centre.

In preparation of the project the University of Columbia, with the support of the bilateral Zambian Multisectoral HIV Programme, carried out a randomised control trial to determine the selection of participants for the JIC. The ESA RP appointed a consultant to support the implementation, and monitoring and evaluation of the project. Some of the methods used included routine visits and observations, pre- and post-visit surveys, focus group discussions with partners and key stakeholders, and reviewing monitoring and reporting tools from the implementing partners to measure the effectiveness of the intervention.

Lessons learnt

This project has highlighted the succes of combining health information and sensitisation activities in the school environment. Young people often do not have information on health services and lack motivation to use health services. However, this project has outlined the willingness of learners to use services in high numbers when health services are provided in an appropriate way and are easy to reach. The mobile health provision was a key success factor in this approach. The involvement of the support environment was another key success factor. Parents and teachers were involved in the information and sensitisation activities, which took place before and during the service provision and were carried out by trained health care providers. In this way, they made a vital contribution to facilitate the access of learners to the services by giving consent to those that are younger than 16 and by motivating the others. A further contributing success factor of the intervention was good planning, which allowed smooth implementation and the ability to adress a bottleneck at an early stage. Before the start of the implementation, preparatory meetings were held with all implementing partners. Further monthly meetings were held during the implementation. Finally, information dissemination on the available health services and referrals have further added a perspective beyond the scope of this project by making learners aware of available services nearby and motivating them to proactively take care of their own health.

Reference

Sabine Diallo and the GIZ Regional Programmeon the Eastern and Southern African Commitment for technical and financial support to produce this handbook.

Huzeifa Bodal and the German Zambian Multisectoral HIV/Aids Programme.

Statistics - Zambia
Linking CSE, AYSRH and JIC Projects
CSE Approach - Zambia, Country Profile


Report - Linking CSE, AYSRH and JIC Projects

REGIONAL MAP


Main partners
Ministry of General Education of Zambia, Planned Parenthood Association of Zambia (PPAZ) Livingstone, Network of Zambian People Living with HIV/AIDS (NZP+), Mboole Rural Development Initiative (Mboole), Brethren in Christ Church Choma Children Development Project (BICC Choma), Multisectoral HIV Programme of Zambia
Target group
10- to 19-year-old learners (boys and girls)
Place
Livingstone and Choma in the Southern Province
Duration
01–12/2017
Activity
Provision of sexual and reproductive health (SRH) services in combination with awareness-raising and sensitisation activities
Results
Access to preventive health care at 101 schools, uptake of SRH services by 1 871 young girls and boys.