After four years, the Regional Support Programme, designed to give a boost to the Eastern and Southern Africa (ESA) Ministerial Commitment to youth sexual health and rights, is coming to a close.
The densely populated ESA region has one of the world’s highest concentrations of youth in distress. With 1,1 million new HIV infections per year – the highest in the world – an estimated 50 young people (two thirds of them girls) are infected with HIV each hour. The ESA region also has the world’s highest rates of Sexually Transmitted Infections (STI), early and unintended pregnancies, and gender-based violence. Contributing factors include young people’s often insufficient knowledge on sexuality and HIV prevention and a lack of youth-friendly health services, in a social and family context that tends to discourage open discussion of young people’s sexuality. Widespread poverty and youth unemployment foster risky behaviour, and traditions such as early marriage and some puberty rituals also take a toll. Youth living with HIV are particularly marginalised.
This is why, in December 2013, Ministers of Health and Education from 20 countries of the ESA Region joined together in the ESA Ministerial Commitment on Comprehensive Sexuality Education (CSE) and Sexual and Reproductive Health (SRH) services for the region’s 174 million young people between the ages of 10 and 24 years. The ESA Road Map 2020 outlines five priority targets to be achieved by the year 2020: reducing new HIV infections and early/unplanned pregnancies, increasing comprehensive knowledge on HIV prevention, and eliminating gender-based violence and child marriage. This high-level commitment is administered by the East African Community and the Southern African Development Community. It receives strong support from the United Nations family under the lead of UNAIDS and a number of international development partners including Germany.
A regional support programme building on dynamic ongoing initiatives
With relevant programmes running in nine of the 20 ESA countries, and following a series of short-term initiatives in favour of the ESA Commitment, in 2015 the German Ministry of Economic Cooperation and Development (BMZ) launched its regional support programme, implemented by the German Development Agency GIZ, with a total budget of 5,2 million Euros for four years. With a programme office in South Africa and links to existing German-supported programmes in the region, the ESA Regional Programme focussed its support in four ‘cluster’ countries: Mozambique, Namibia, South Africa, and Zambia. Taking a resolutely bottom-up and multisectoral approach, it linked up to existing initiatives and created synergies with ongoing multilateral and bilateral cooperation programmes.
As Sabine J. Diallo, Coordinator of the ESA RP, explains, “The ultimate goal is to strengthen young people’s participation and voices in the ESA Commitment implementation process through transnational dialogues, involvement in coordination committees and other measures. The specific needs of young people living with HIV is a particular focus of this process.”
Tailor-made solutions adapted to local realities
To confront the twin challenges of young people’s insufficient awareness of and access to sexual and reproductive health services, the Regional Programme was aligned on the ESA Commitment’s two foci: Comprehensive Sexuality Education (CSE) and youth-friendly SRH services – and increasingly, the linkages between the two. In its four cluster countries the ESA Regional Programme identified promising ongoing initiatives of well-established national and local partners for support, further development and potential scale-up:
- In Mozambique the programme worked with Geração Biz (‘Busy Generation’), the national programme implementing sexual and reproductive health services for youth, jointly run by the Ministries of Education, Health and Youth on both national and provincial Levels.
- In Namibia the program partnered with the Ministry of Education, Arts and Culture, and on regional level with various school health taskforces.
- In South Africa the programme’s partner was the South African National AIDS Council (SANAC) as well as the Department of Basic Education, the Department of Health and provincial departments in Mpumalanga, Northern Province and Eastern Cape.
- In Zambia the Regional Programme worked with the National AIDS Commission, as well as the Ministry of General Education, regional education and health services and local service providers in the Southern Province as well as Planned Parenthood.
This careful, ‘subsidiary’ approach is appreciated as conducive to ownership and sustainability by Tsenolo Moruthoane, M&E Manager at SANAC: “GIZ came on board on activities the nation has already started moving with – this is a basis for sustainability, the ownership lies within the hand of the nation.”
Transnational Learning Hubs
Going a step further, the Regional Programme then initiated critical exchange and reciprocal learning among country and regional stakeholders, through webinars and yearly face-to-face encounters in Transnational Learning Hubs, asking questions like ‘What exists? What works? What could be useful for potential scale-up?’ Planning sessions and regular webinars within country groups ensured that decisions were made on how to proceed with implementation of the ESA Commitment and on the concrete steps to be taken.
“It is not a question of ‘copying’, but of mutually advising one another,” explains Tshepo Ngoato of South Africa, founder and CEO of Smart Health and Y+, two NGOs for and by youth living with HIV. “The ESA Regional Programme helped me learn from others, like, how can I take that program and how can I take the learning from that one, for instance from Zambia, and combine the two approaches?”
Empowering youth and ensuring Comprehensive Sexuality Education
Empowering youth through a demand-led, gender-sensitive, human-rights-based approach has been a constant focus of the Regional Programme. Bechir N'Daw, UNAIDS Senior Advisor for Political Partnerships and Social Justice, agrees: “More space needs to be given to young people. We need platforms to ensure that young people come together, build up their capacities and become the drivers of the programmes.” In all four countries, NGOs for and by young people were involved in planning and implementing the programme-supported activities, thus becoming active agents of their own destiny.
Comprehensive Sexuality Education (CSE) aims to support this transformation. Given in school (and more rarely, outside school) CSE should impart not only factual knowledge on human sexuality, but also practical know-how relevant for the learner (how can I protect myself in such and such a situation?), and an attitude of self-reliance (I am confident that I can protect myself and others). CSE had been introduced to varying degrees in the different countries in subjects such as Life Sciences, but in 2015 the ESA Commitment took a major step to reinforce the approach through introduction of an online teacher-training course on CSE developed by UNESCO and UNFPA and offered by the Foundation for Professional Development, based in South Africa.
The GIZ Regional Programme complemented these efforts, in partnership with the respective Education Ministries, by providing technical and financial support to training of 1,256 primary- and secondary-school teachers in the four countries. GIZ commissioned a detailed needs assessment which identified teachers’ need for additional tools, including teaching guides, which were then developed with country stakeholders.
What was learned on the way?
Sabine J. Diallo explains, “Although coordinating within a gigantic network such as the ESA Initiative was not always simple, working with our national partners in the four cluster countries kept our Regional Programme grounded. The transnational learning hubs, where representatives from all countries meet to exchange in person, are very effective for creating connections among participants – but also very expensive. We therefore introduced different formats, such as webinars, to maintain regular contact among government partners, civil society organisations and youth representatives from all four countries.”
In organising the CSE online course for training teachers in the four countries, GIZ improved learning conditions by assembling groups of 50 to 200 teachers for a structured two- to three-day programme, with trainers to guide them through the process. When many teachers turned out to be unfamiliar with computers, technicians were added to initiate them in basic skills and support them in completing the online curriculum.
Social acceptance of CSE, wrongly suspected of encouraging sexual experimentation by schoolchildren, remains a persistent problem. Julius Nghifikwa, Deputy Director of Namibia’s Ministry of Education, observes, “We are still facing resistance, 50 percent are convinced to move ahead with CSE, but 50 percent are still hesitant. This is why we need to intensify advocacy. We need to convince everyone that CSE and SRH are central and we need to move ahead with them.”
To make the social environment more accepting of CSE and youth SRH, Zambia has embarked with GIZ support on a nationwide Intergenerational Dialogue involving parents, churches and traditional leaders.
Ellen Mubanga, Coordinator in Zambia’s National AIDS Council, wants to ensure sustainability of this initiative: “When we were designing our national action plan for the Global Prevention Coalition in Zambia, we integrated the intergenerational dialogue as one of the core activities in order to sustain its implementation.”
The best guarantee for the ESA Commitment’s sustainable implementation is ist integration into national plans and strategies. In its National Strategic Plan on HIV, Tuberculosis and STIs for 2017–2022, South Africa’s SANAC integrated two major indicators of the ESA Commitment under Goal one: “Provision of sensitive and age-appropriate sexual and reproductive health services and comprehensive sexuality education”. The entire ESA region, with as key ministries Health and Education, has committed to follow South Africa’s example.
What has been achieved?
Each of the four countries has a large number of impressive results on the road to fulfilling their ESA Commitment. They have effective coordination mechanisms for ESA implementation in place and networking between them has strengthened learning and innovation. South Africa has integrated the ESA Commitment into its national strategic planning, and other countries are following suit.
Inputs from youth have been crucial to developing suitable interventions. A regular exchange network, with a particular focus on young people living with HIV, was established between the NGOs Y+ South Africa, Tonata from Namibia, NZP+ from Zambia and REJUSIDA from Mozambique. Young people’s organisations from the four countries made recommendations at high-level ministerial panel discussions on youth participation in achieving the ESA targets.
The Regional Programme has trained a total of 1,256 teachers, who in turn have educated half a million primary- and secondary-school students in the four countries. Based on the needs assessment, a teaching aid was developed for SANAC. Namibia and Zambia have each also developed teaching aids for CSE. Zambia’s Teaching Guide, based on an assessment by the Ministry of General Education, is aligned with the Zambian curriculum, cultural values, laws and policies. It guides teachers on the use of age-appropriate and learner-centred approaches.
In Mozambique demand for youth-friendly health services has risen, thanks to a number of initiatives including school ‘health corners’ and over 7,000 ‘mentor volunteers’ on community level, who reached more than 700,000 youth in 2017. That same year over one million young people accessed youth-friendly RHS in health facilities. During an assessment mission on linking CSE and youth SRH it was repeatedly stated that the number of early pregnancies and related school dropouts had decreased significantly.
In Namibia the Ministry of Education associated the Ministry of Health in creating the National School Health Task Force focussed on implementing the ESA Commitment. In the Ohangwena Region, 40,000 learners were sensitised on HIV prevention and teenage pregnancy, 5,000 were tested for HIV through mobile services, and uptake of HIV Counselling and Testing (HCT) services by young people at the youth-friendly Eenhana clinic increased by 240 percent. The activities of the Ohangwena Youth Health Task Force were presented as good practice in 13 regions and documented in a handbook and in the movie ‘Together we shine’.
In South Africa, SANAC plays the role of a regional locomotive in coordinating the National Strategic Plan for HIV, Tuberculosis and STIs reflecting priorities of the ESA Commitment. It has perfected a CSE multi-sectoral data integration and reporting framework and is ready to start working with it in Mpumalanga Province.
In Zambia a total of 101 schools took part in an initiative associating the Join-In Circuit with mobile health services. 1,871 girls and boys aged 10-19 accessed these services. Njapau Samson from the Ministry of General Education in Zambia highlights the importance of community involvement in CSE: “The step we have taken in Zambia is to sensitise members of community including parents, traditional leaders, guardians and others around the benefits of providing CSE to in- and out-of-school youths.” The recently initiated Intergenerational Dialogue has already reached 403 people across 12 districts, with 32 percent aged 15-24 years, while 57 percent were over 34.
How will the initiatives continue?
After a final Transnational Learning Hub meeting, the GIZ Regional Programme is ending. However, the participants are determined to pursue and further develop their activities. Rito Massuanganhe, Civil Society Coordinator in Mozambique’s National AIDS Council, reflects: “One way to guarantee sustainability of actions is to integrate these actions in the plans of the engaged departments. CSE should be integrated in the teaching curriculum, for instance. These national plans can be used as guiding documents for development partners’ engagement. This guarantees core activities are covered.”
Takaengwa Macheka of the Mpumalanga Provincial AIDS Council in South Africa, adds: “Sustainability also is about empowering people in the communities. You will be amazed how communities are having strategies and programmes of their own and these are the ones that survive when external support is ending. Engaging and empowering communities is a basis for sustainability, communities are thinking along and know what is needed.”
The brief history of the GIZ Regional Programme is one of innumerable smaller and larger triumphs, but above all, one of fostering new ways of working together with people near and far for the greater well-being of ESA’s new Generation.