Promoting Adolescent Sexual and Reproductive Health in East and Southern Africa by Alan J. Flisher, Knut-Inge Klepp, and Sylvia F. Kaaya


00412d06_medium.jpg Author Alan J. Flisher, Knut-Inge Klepp, and Sylvia F. Kaaya
Isbn 9789171065995
File size 2MB
Year 2008
Pages 344
Language English
File format PDF
Category fitness



 

Free download from www.hsrcpress.ac.za Indexing terms: Adolescents Reproductive health Sexual behaviour Sex education Health programmes Health service AIDS prevention Social change Case studies East Africa Southern Africa Language checking: Elaine Almén Index: Jane Coulter Cover: FUEL Design, Cape Town © The authors and Nordiska Afrikainstitutet 2008 P.O. Box 1703, SE-751 47 Uppsala, Sweden www.nai.uu.se ISBN 978-91-7106-599-5 Published in South Africa by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpress.ac.za ISBN 978-0-7969-2210-6 Printed in Sweden by Alfa Print 2008 Contents Preface ……………………………………………………..…………………………………………………… Introduction ………………………………………………………………………………………………… 5 7 Free download from www.hsrcpress.ac.za Part I Policy and Theory Informing Practice 1. Public Policy: A Tool to Promote Adolescent Sexual and Reproductive Health ………………..………………………………………………………… Yogan Pillay & Alan J. Flisher 2. Social Cognition Models and Social Cognitive Theory: Predicting Sexual and Reproductive Behaviour among Adolescents in Sub-Saharan Africa ………………………………………………… Leif E. Aarø, Herman Schaalma & Anne Nordrehaug Åstrøm 3. Health Education and the Promotion of Reproductive Health: Theory and Evidence-Based Development and Diffusion of Intervention Programmes ……………..…………………………… Herman Schaalma & Sylvia F. Kaaya 4. Ethical Dilemmas in Adolescent Reproductive Health Promotion ……………………………………………………………………………… Gro Th. Lie 15 37 56 76 Part II Contextual Aspects of Adolescent Sexual and Reproductive Health 5. From Initiation Rituals to AIDS Education: Entering Adulthood at the Turn of the Millenium ……………………… Graziella Van den Bergh 99 6. Illegal Abortion among Adolescents in Dar es Salaam ……..………… 117 Vibeke Rasch & Margrethe Silberschmidt 7. Adolescent Sexuality and the AIDS Epidemic in Tanzania: What Has Gone Wrong? …………………………………………… 135 Melkizedeck T. Leshabari, Sylvia F. Kaaya & Anna Tengia-Kessy 8. To Risk or not To Risk? Is It a Question? Sexual Debut, Poverty and Vulnerability in Times of HIV: A Case from Kigoma Region, Tanzania ………………………… 162 Graziella Van den Bergh Free download from www.hsrcpress.ac.za Part III Addressing the Needs of Adolescents: Arenas for Action 9. Peer Education for Adolescent Reproductive Health: An Effective Method for Program Delivery, a Powerful Empowerment Strategy, or Neither? … ………………………… 185 Sheri Bastien, Alan J. Flisher, Catherine Mathews & Knut-Inge Klepp 10. Adolescent-Friendly Health Services in Uganda …………………………… 214 John Arube-Wani, Jessica Jitta & Lillian Mpabulungi Ssengooba 11. Quality of Care: Assessing Nurses’ and Midwives’ Attitudes towards Adolescents with Sexual and Reproductive Health Problems ………………………………………………………… 235 Elisabeth Faxelid, Joyce Musandu, Irene Mushinge, Eva Nissen & Mathilde Zvinavashe Part IV Evaluation and Review of Interventions in Sub-Saharan Africa 12. Evaluating Adolescent Sexual and Reproductive Health Interventions in Southern and Eastern Africa … ……………………………… 249 Alan J. Flisher, Wanjiru Mukoma & Johann Louw 13. A Systematic Review of School-Based HIV/AIDS Prevention Programmes in South Africa ………………………………………… 267 Wanjiru Mukoma & Alan J. Flisher Bibliography ……………………………………………………………………………………………… 288 Contributors ……………………………………………………………………………………………… 327 …………………………………………………………………………………………………………… 333 Index Free download from www.hsrcpress.ac.za Preface The basis for this volume emerged out of the extensive collaboration born out of the Adolescent Reproductive Health Network (ARHNe), which lasted from 1997–2001. This was a European Union-funded concerted action project which developed the competence and capacity of researchers in East and Southern Africa to engage in health promotion activities (particularly in the area of reproductive health). Specifically, the main objectives of the ARHNe were to: – strengthen and further develop research and practice related to the design and delivery of sexual and reproductive health-related services and programs targeting adolescents – foster the development and application of trans-disciplinary theories, conceptual models and research methods relevant to the study of adolescent health, and ultimately develop culturally appropriate intervention programs to modify adolescent health-related behaviors – facilitate technical co-operations between African researchers and between African researchers and their European colleagues in order to stimulate a productive scientific context for ongoing programs and to reduce the risk of costly, uncoordinated duplication of research In response to the need to articulate new perspectives and strategies on promoting adolescent sexual and reproductive health, the network researchers working in East and Southern Africa represented a unique and comprehensive attempt to bring together the social and biomedical sciences in an effort to disseminate concrete empirical evidence from diverse vantage points. This book ultimately represents a tool that may be utilized not only by academics in the field, but also by practitioners, governments, policy makers and students interested in the future research agenda, priorities and challenges of sexual and reproductive health in the wake of several international commitments.  We would like to thank all of our colleagues who over the years participated in the ARHNe project workshops and who contributed to the scientific discussions that stimulated the writing of this volume. Furthermore, we would like to thank the European Commission for their generous support through the ARHNe grant (Contract no. ERBIC18CT970232) and the University of Oslo which supported this work through the Centre for Prevention of Global Infections (GLOBINF), a thematic research area at the Faculty of Medicine. Finally, our grateful appreciation goes to Ms. Sheri Bastien for her editorial assistance during the final stages of this book project. Free download from www.hsrcpress.ac.za Oslo, Cape Town and Dar es Salaam, October 2005 Knut-Inge Klepp  Alan J. Flisher Sylvia F. Kaaya Introduction Knut-Inge Klepp, Alan J. Flisher and Sylvia F. Kaaya Free download from www.hsrcpress.ac.za Primary prevention and health promotion: A focus on adolescents In the realm of global health research, adolescent sexual and reproductive health has emerged as an area of key concern, particularly in developing nations and regions such as sub-Saharan Africa where HIV and AIDS account for the second highest number of deaths. Globally, one-fourth of these cases represent people under the age of 25 years, with 63 per cent residing in subSaharan Africa (UNAIDS, 2004). Young women are three times as likely as young men to be infected. Adolescents in East and Southern Africa are also faced with a host of potential sexual and reproductive health problems in addition to HIV/AIDS, such as sexually transmitted infections, unwanted pregnancies, unsafe abortions, contraception, sexual abuse and rape, female genital mutilation and circumcision, and maternal and child mortality. Young people under the age of 25 constitute an important group given that they comprise approximately half of the global population and are ultimately the future adult citizenry. Indeed, the health of a nation’s young people and its vulnerability serve as a barometer for the health of wider society. In recognition that the sexual and reproductive health needs of adolescents differ markedly from those of adults, nations are now increasingly placing the issue firmly on their development agendas. Yet despite being at the center of the HIV epidemic in terms of transmission, vulnerability and impact, the vast majority of adolescents encounter significant barriers to maintaining their sexual and reproductive health, such as stigma and discrimination, lack of access to youth-friendly services, critical information, and programs which are designed to equip them with the skills and services they need for prevention, treatment and care. Moreover, the period of adolescence and the transition to adulthood varies widely from society to society and is marked in different ways and at different ages. Consequently, adolescents may face different challenges and have different opportunities which may impact their sexual and reproductive health.  Knut-Inge Klepp, Alan J. Flisher and Sylvia F. Kaaya Free download from www.hsrcpress.ac.za The research agenda The widely recognized 10/90 imbalance, whereby 10 per cent of funding worldwide is spent on diseases which afflict 90 per cent of the population makes collaborative research, capacity building and dissemination efforts by networks such as ARHNe critical to achieving the substantial progress necessary for narrowing the gap. A number of international agreements and initiatives have been made in the last decade which also underpin the network’s activities and form the core of this volume’s efforts in the field of sexual and reproductive health. The International Conference on Population and Development (ICPD) in Cairo, has been instrumental in affirming the status of reproductive rights as basic human rights to be enjoyed by all and the importance of gender equality in facilitating development and alleviating poverty, while at the same time acknowledging the need to address the underlying mechanisms which perpetuate ill health and stand in the way of the realization of those rights. Two additional international commitments underpinning the network’s activities are the UN Convention on the Rights of the Child (1989) and the UN’s Millennium Development Goals (MDGs), as reflected in a number of the chapters in this volume. These instruments, which are built on an understanding that the rights, safety, health and well-being of children and young people, are imperative to the development process of nations and are intrinsically linked, reinforced, and complemented by each other. Our understandings of sexual and reproductive health have matured to the point that it is now widely acknowledged that personal, social, structural and environmental factors often beyond the scope of individual control are instrumental in making sense of the diversity of factors which combine to shape sexual behavior. Understanding the complex interplay of these factors, which may simultaneously work to constrain or facilitate individuals in negotiating any given behavior, has become a focal point for researchers engaged in prevention and health promotion activities. The contributions in this volume are built on this premise that sexual and reproductive health behavior is multifaceted and that interventions must consequently be aimed at a number of levels: the individual, organizational and governmental; and at settings such as the school, worksites, health care institutions and communities. Accordingly, the diversity of chapters contained in this volume provides entry points for understanding adolescent sexual and reproductive health at the policy, theoretical and ethical levels, at the community level, at the health services level and at the school level.  Free download from www.hsrcpress.ac.za Introduction The authors aim to address some of the most salient issues to have emerged from recent research, including: the role of policy in planning adolescent sexual and reproductive health programs; the applicability of Western theories and models in the African context; the role of the media; the centrality of gender and its construction to sexual and reproductive health; the use of peer educators as change agents; the provision of youthfriendly health services; the current ethical challenges facing the field; and the need for rigorous evaluation of programs. Superimposed on all of these issues, social change and the tension between the old and new ways of thinking and being, emerge as an overriding theme. Social, economic and political forces are rapidly altering the manner in which young people and adolescents grow up, having significant implications for their education, future employment and sexual and reproductive health. In sub-Saharan Africa, this is readily apparent in uneven, yet steady changes in terms of gender norms and expectations as evidenced in familial structures, the education and employment sectors, the media, and in policy. Similarly, our understandings of African sexuality have become more sophisticated and nuanced, which have prompted researchers to revisit critical issues related to how sexual and reproductive health interventions are conceived within certain frameworks; ultimately, how they are planned and implemented at all levels of analysis from policy to theory, ethics and practice. Comprehensive overview The volume is divided into four sections, with each section building on and reinforcing the others. The first section lays the groundwork by focusing primarily on the policy and theoretical underpinnings of sexual and reproductive health promotion. Having established the premises upon which interventions are built, the second section highlights a number of contextual issues surrounding adolescent sexual and reproductive health, and draws examples from studies conducted in a number of countries in East and Southern Africa through anthropological, sociological and psychological lenses. The third section of the book rounds out the first two sections by looking at the settings and arenas typically targeted by interventions, such as schools and health facilities. The fourth and final section of the volume consists of two chapters which appropriately sum up current findings in the literature by providing comprehensive reviews and evaluations of reproductive health interventions in Southern and East Africa.  Free download from www.hsrcpress.ac.za Knut-Inge Klepp, Alan J. Flisher and Sylvia F. Kaaya In Chapter 1, public policy as a tool for promoting adolescent sexual and reproductive health is explored by looking at the processes involved in policy development and the inherent challenges it entails. This chapter highlights a theme recurrent throughout the volume, which is the centrality of adolescent participation in planning to maximize effectiveness and relevance of programming. In Chapter 2, a critical examination of the usage and applicability of social cognitive models designed in Western contexts, suggests that while these models may have relevance to African settings, sufficient attention must be paid to underlying cultural, structural and environmental factors which may compromise the efficacy of prevention or health promotion programs. In a similar vein, Chapter 3 questions the ability of interventions conceived in the West to be successfully transplanted to African contexts, given cultural, social and economic specificities. The authors introduce the Intervention Mapping (IM) approach as an alternative to developing and diffusing HIV prevention programs, which enables a more sophisticated and contextually aware understanding of the target population. Exploring the fundamental ethical dilemmas intrinsically involved in research in general and health promotion in particular, Chapter 4 raises important questions to be considered by researchers in the field and underscores the continuous need for reevaluating and revamping guidelines to keep pace with changing methodologies and practices. The recent emphasis on child participation is again raised in light of the new ethical dilemmas participation poses. At the outset of Section II, Chapter 5 draws on the aforementioned theme of social change and attempts to make sense of the historical, sociocultural, political and economic contexts in which sex education has shifted from traditional initiation rituals to more explicit school-based learning. In this way, the chapter explores some of the more distal factors impinging on interventions that were detailed in the first section, in order to explain how and why sexual behavior is changing, and ultimately the implications of this for interventions. The dire implications of illegal abortion for the sexual and reproductive health of adolescent girls and the importance of addressing the lack of available youth-friendly health services is focused on in Chapter 6. The findings here demonstrate that lack of knowledge and access to services such as safe, legal abortion for adolescent girls is a pressing issue that needs to be addressed through policy and backed up by action and services. Developing these findings more broadly, Chapter 7 addresses the barriers adolescents face in negotiating safe and healthy sexual behavior by linking current sexual behavior in Tanzania to ongoing social and eco10 Free download from www.hsrcpress.ac.za Introduction nomic changes. Returning to the theme of social change, Chapter 8 takes a look at how vulnerability and the onset of sexual behavior are shaped in the context of HIV in Tanzania. Section III begins with Chapter 9, which provides an in-depth look at the increasing use of peer educators in the field of health promotion and sexual and reproductive health, with particular focus on interventions in sub-Saharan Africa. Health services geared towards adolescents in Uganda are detailed in Chapter 10. This chapter demonstrates how understandings of the needs of adolescents for health services tailored for their context has grown since the ICPD and provides a look at how this is being implemented on the ground. Similarly, in Chapter 11 the perceptions and attitudes of nurses and midwives who deal with adolescents in health service settings are explored in light of the impact this has on quality of care. These two chapters present important empirical data in an area where there is relatively little research documenting the effectiveness of youth-friendly health services in terms of their ability to attract young people, adequately meet their needs and ultimately, the outcome of their sexual health. Finally, the last section of the book culminates in two chapters which are comprehensive reviews and evaluations of sexual and reproductive health and school-based interventions in sub-Saharan Africa, in order to highlight what has been done thus far and to identify the gaps in the literature which need to be addressed in future research. The chapters in this volume aim to contribute new knowledge and evidence of the manner in which interventions through schools, the media, health services and community can contribute to the sustained sexual and reproductive health of adolescents. Identifying and scaling up successful interventions and implementing national strategies and policies backed by solid empirical data and financial commitment is critical to ensuring the present and future generation live long, healthy and productive lives. This volume represents an attempt from a research perspective to bridge the gap between policy, theory, rhetoric and action and in that way make a modest contribution to this ambitious agenda. 11 Free download from www.hsrcpress.ac.za Free download from www.hsrcpress.ac.za I Policy and Theory Informing Practice Free download from www.hsrcpress.ac.za 1. Public Policy: A Tool to Promote Adolescent Sexual and Reproductive Health Yogan Pillay and Alan J. Flisher Free download from www.hsrcpress.ac.za Abstract The term policy refers to an organised set of a vision and sets of values, principles, objectives and general strategies. Public adolescent sexual and reproductive health policy has the following purposes: to change behaviour at the individual and collective levels; to facilitate a higher priority being assigned to adolescent sexual and reproductive health; to establish a set of goals to be achieved, upon which future action can be based; to improve procedures for developing and prioritising adolescent sexual and reproductive services and activities; to identify the principal stakeholders in the field of adolescent sexual and reproductive health and to designate clear roles and responsibilities; and to achieve consensus of action among the different stakeholders. There are six key processes in developing policy: collect information; develop consensus; obtain political support; implement pilot projects; review; and solicit international support and input. In general, it is the responsibility of a task team or committee to carry out these activities. In developing policy, member states of the United Nations and regional multilateral organisations have an obligation to take into consideration treaties, conventions and instruments adopted by these bodies. There are several such agreements, including the Convention on the Rights of the Child, Programme of Action of the United Nations International Conference on Population and Development (ICPD), Programme of Action adopted at the United Nations Fourth World Conference on Women, African Charter on the Rights and Welfare of Children, and the Protocol on Health in the Southern African Development Community. Policies are more likely to be acceptable to adolescents if they are consulted and involved in the development of policies and their implementation. Governments need to commit resources to ensure that policies are effectively implemented and sustainable, which requires political and financial stability. 15 Yogan Pillay and Alan J. Flisher Policy is the thread of conviction that keeps a government from being the prisoner of events… (Ignatieff, 1992, quoted in Walt, 1994, p. 41.) Free download from www.hsrcpress.ac.za What is policy, and why do we need it? The term policy refers to an organised set of a vision and sets of values, principles, objectives and general strategies. The development of policy occurs at many levels, for example the individual and public levels (Pillay, 1999). An example of a simple individual level policy is the decision to use a condom or to be monogamous, while an example of a public policy is the decision to permit termination of pregnancy in specified circumstances. These examples provide a clue as to why we need policy. At the most basic level, policies are intended to influence behaviour at either the individual or collective level. Public adolescent sexual and reproductive health (ASRH) policy may also have the following additional purposes (World Health Organisation, 2001): – to ensure that a higher priority is assigned to adolescent sexual and reproductive health; – to establish a set of goals to be achieved, upon which future action can be based; – to improve procedures for developing and prioritising adolescent sexual and reproductive services and activities; – to identify the principal stakeholders in the field of adolescent sexual and reproductive health and to designate clear roles and responsibilities; and – to achieve consensus of action among the different stakeholders. Policies may also have unintended negative consequences. For example, whilst the legalisation on termination of pregnancy aims to give adolescents increased control over their reproductive health and to prevent the negative effects of ‘back-street abortions’, it may also result in teenagers using termination as their primary family planning method. Policies differ from, but are related to, legislation. Institutions use policies as rules or guidelines to shape their behaviour. Legislation should be based on policy. It is related to policy in that they both set out to shape behaviour. However, legislation (unlike policies) also provides for sanctions and penalties. Once a policy is promulgated, it becomes an offence in terms of the law not to implement the policy. A further, related, difference between policies and legislation is that legislation provides more certainty 16 1. Public Policy: A Tool to Promote Adolescent Sexual and Reproductive Health than does the policy on which it is based. The vague and ambiguous aspects of a policy need to be clarified when translating a policy into legislation. How do we develop policy? There are six key processes in developing policy: (a) collect information; (b) develop consensus; (c) obtain political support; (d) implement pilot projects; (e) review; and (f) solicit international support and input (World Health Organization, 2001). In general, it is the responsibility of a task team or committee to implement these steps. Free download from www.hsrcpress.ac.za Collect information Ideally, data in three domains inform the development of ASRH policy. First, one needs to have a situation analysis for each area that will be included in the policy. This is necessary to inform priorities and form a baseline to use in evaluating the effect of a policy. For example, if one is to develop policy to reduce the extent of unsafe sexual behaviour in a population of adolescents, one needs answers to basic questions, like: – What is the prevalence rate of sexually transmitted diseases such as HIV infection among health facility users or community samples? – What are the routes of HIV infection? – What proportions of adolescents in each age and grade cohort engage in sexual intercourse and other forms of sexual behaviour? – Are the sexual partners peers, as opposed to older adults? – How well do the partners know each other? – Are the partners in a committed relationship, or is their relationship driven mainly by spontaneous sexual desire? – Are the sexual encounters characterised by violence, or threats of violence? – What is the partner “turnover” rate? – How many partners do adolescents have both serially and concurrently? – What do they do to prevent pregnancy and sexually transmitted infections (such as AIDS)? – What are the social norms around sexual behaviour in the peer, family and community domains? 17 Yogan Pillay and Alan J. Flisher Free download from www.hsrcpress.ac.za – What is the influence of the following variables on sexual behaviour: self-efficacy for safer sexual practices, intent, knowledge about sexuality, and social and material barriers? – Are there economic reasons for such behaviour? In many cases, this information is not available. In this case, steps need to be taken to fill the gaps. Such steps can include embarking on new quantitative or qualitative studies, conducting rapid appraisals, convening expert panels and extrapolating from studies conducted in similar environments. Reviews may be useful in extrapolating from other contexts; for example, there are reviews of adolescent sexual behaviour in school populations in Sub-Saharan Africa (Kaaya et al., 2002b) and adolescent and youth sexual behaviour in South Africa (Eaton et al., 2003). The second domain in which data are necessary to inform the development of ASRH policy is the impact of the scenario described in the situation analysis. If one stays with the example used above, one will need to understand the nature and extent of the consequences of unsafe sexual behaviour. Thus one would need to know the rates of unwanted pregnancy, terminations of pregnancy and sexually transmitted diseases such as HIV infection. Overall rates are necessary, especially for garnering support from key stakeholders and raising public awareness. However, for policy purposes it is also important to disaggregate such data according to key demographic variables such as age, gender and location. This will enable the policy to be fine-tuned to ensure that rates in high-prevalence groups are reduced while rates in low prevalence groups remain low. The final domain in which data are necessary is around interventions. Policy decisions about interventions should be based on the best available scientific evidence about the efficacy and impact or effectiveness of potential interventions (Flisher et al., 2008). Again to pursue the above example, with regard to school-based sexual and reproductive health promotion efforts, a considerable body of evidence has emerged about the characteristics of effective programmes (Kirby et al., 1994; Mukoma and Flisher, 2008). New policy should take existing evidence into account. However, it is still necessary to develop programmes that are appropriate for each context. The chapter by Schaalma and Kaaya (2008) provides guidance on how to do this. 18 1. Public Policy: A Tool to Promote Adolescent Sexual and Reproductive Health Free download from www.hsrcpress.ac.za Develop consensus The content of policies reflects the relative power of those influencing their content. According to Walt (1994), writing in the context of health policy specifically, health policy is about content, process and power: “It is concerned with who influences whom in the making of policy, and how that happens” (p.1). Partly for this reason, it is essential that the policy making process includes all key stakeholders. Prime among these are representatives of the group whose health the ASRH policy aims to address, namely adolescents themselves. Thus, it is important for policy makers to consult with adolescents and their representatives to ensure that their views influence the content of the policies, and that interventions take into consideration their objective and subjective realities. Failure to do so may result in inappropriate policies being adopted and difficulties in the implementation of these policies. It is also crucial to include representatives of other sectors (besides the health sector) in the development of adolescent sexual and reproductive health, for two main reasons. First, there are a range of fundamental socioeconomic conditions that are essential for adolescent health, such as peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, equity (Ottawa Charter, 1996). Second, these fundamental conditions can have an impact on the effectiveness of interventions. Adolescents, for example, are unlikely to be receptive to information about the importance of safer sex practices if they are homeless and dependent on income derived from commercial sex. In most cases, these conditions are not directly addressed in ASRH policies. However, it is necessary to ensure that policies, plans and programmes in other sectors support ASRH policy, by taking cognisance of the needs of adolescents. Thus, the involvement of other sectors is necessary to maximise the chances of this occurring. Box 1 lists the stakeholders that participated in the development of the National Adolescent and Youth Health Policy Guidelines in South Africa. Obtain political support Political support is necessary both during the development and implementation of policy. It facilitates a stable environment for implementation. Health workers and others responsible for policy implementation are more likely to be committed to a policy if it is not merely a short-term political priority. Related to this is that political support produces higher levels of accountability from those tasked with implementation. They are more likely to be 19 Yogan Pillay and Alan J. Flisher Free download from www.hsrcpress.ac.za called to account by politicians, and a failure to deliver may be more likely to have negative consequences. Finally, political support is necessary to secure sustained or increased funding. In a recent editorial in The Lancet, its editor Horton highlights the negative consequences of political influence on public health policy using the current US government’s attitude to abortions and the spill-over effect on such institutions as the US Centers for Disease Control and Prevention. He notes: “(this) culture of political censorship and fear, which now pervades many public-health institutions when reproductive health is at issue, is not only damaging the reputations of once highly regarded agencies…but also blunts the global contributions they can make” (Horton, 2006, p. 1549). Implement pilot projects Pilot projects can provide useful evidence from the beginning of a policy development process (Abeja-Apunyo, 1999). They can demonstrate that a programme is feasible in a subset of the sites for which it is being developed, which provides reassurance before rolling it out more broadly. They can indicate which aspects need to be improved, and contribute to estimates of the costs of implementing a policy. An example of a pilot project is the Programme for Enhancing Adolescent Reproductive Life (PEARL), which was started in four pilot districts in Uganda in 1995. Its objective was to enhance adolescent reproductive health by providing adolescents with appropriate reproductive health counselling and services. A national steering committee was established to oversee the project and included: the Ministry of Gender, Labour and Social Development, the Ministry of Health and the Population Secretariat, two district level personnel, a sub-county officer and health unit service provider. The programme was implemented using peer mobilisers and parent/peer educators at parish or local level. In 1997 PEARL was expanded into four new districts and it was planned to expand into four additional districts every year until the entire country was covered. The expansion process will be guided by lessons learned as the project rolls out. Review A comprehensive review of a policy rests on two pillars. First, it is necessary to evaluate the policy itself, for which a framework is necessary. Such a framework can be used not only by people involved in developing policy but also by people who use the policy or are affected by it. Pillay (1999) has 20

Author Alan J. Flisher, Knut-Inge Klepp, and Sylvia F. Kaaya Isbn 9789171065995 File size 2MB Year 2008 Pages 344 Language English File format PDF Category Fitness Book Description: FacebookTwitterGoogle+TumblrDiggMySpaceShare This volume emerged out of the Adolescent Reproductive Health Network (ARHNe), a European Union-funded concerted action project which developed the competence and capacity of researchers in East and Southern Africa to engage in health promotion activities (particularly in the area of reproductive health). The main objectives of the ARHNe were to: strengthen and further develop research and practice related to the design and delivery of sexual and reproductive health-related services and programs targeting adolescents; foster the development and application of trans-disciplinary theories, conceptual models and research methods relevant to the study of adolescent health, and ultimately develop culturally appropriate intervention programs to modify adolescent health-related behaviors; facilitate technical co-operations among African researchers and between African researchers and their European colleagues in order to stimulate a productive scientific context for ongoing programs and to reduce the risk of costly, uncoordinated duplication of research. This book ultimately represents a tool that may be utilized not only by academics in the field, but also by practitioners, governments, policy makers and students interested in the future research agenda, priorities and challenges of sexual and reproductive health in the wake of several international commitments.     Download (2MB) Drug-Induced Infertility and Sexual Dysfunction Intellectual Property and Public Health in the Developing World Occupational Health Infertility in the Modern World: Present and Future Prospects Sexual Dysfunctions: Special Issues Load more posts

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