Experiences of teachers and community-based health workers in addressing adolescents’ sexual reproductive health and rights problems in rural health systems: a case of the RISE project in Zambia

Abstract

Background Adolescents in low-and-middle-income countries like Zambia face a high burden of sexual, reproductive, health and rights problems including coerced sex, teenage pregnancies, and early marriages. The Zambia government through Ministry of Education has integrated comprehensive sexuality education (CSE) in the education and school system to contribute towards addressing Adolescents sexual, reproductive, health and rights (ASRHR) problems. This paper sought to explore teachers and community based health workers (CBHWs)’ experiences in addressing ASRHR problems in in rural health systems in Zambia. Methodology The study was conducted under Research Initiative to Support the Empowerment of Girls (RISE) community randomized trial that aims to measure the effectiveness of economic and community interventions in reducing early marriages, teenage pregnancies, and school dropout in Zambia. We conducted qualitative 21 in-depth interviews with teachers and CBHWs involved in the implementation of CSE in communities. Thematic analysis was used to analyse teachers and CBHWs´ roles, challenges, and opportunities in promoting ASRHR services. Results The study identified teachers and CBHWs roles, and challenges experienced in promoting ASRHR and suggested strategies to enhance delivery of the intervention. The role of teachers and CBHWs in addressing ASRHR problems included mobilizing and sensitizing the community for meetings, providing SRHR counseling services to both adolescents and guardians, and strengthening referral to SRHR services if needed. The challenges experienced included stigmatization associated with difficult experiences such as sexual abuse and pregnancy, shyness among girls to participate when discussing SRHR in the presence of the boys and myths about contraception. The suggested strategies for addressing the challenges included creating safe spaces for adolescents to discuss SRHR issues and engaging adolescents in coming up with the solution. Conclusion This study provides significant insight on the important roles that teachers CBHWs can play in addressing adolescents SRHR related problems. Overall, the study emphasizes the need to fully engage adolescents in addressing adolescents SRHR problems.

Unlocking policy synergies, challenges and contradictions influencing implementation of the Comprehensive Sexuality Education Framework in Zambia: a policy analysis

“…The existence of health policy also motivates actors to collaborate in the implementation of CSE related interventions and empowers them to provide social accountability in providing checks and balances regarding the implementation of CSE Programmes. Studies conducted in LMICs countries also highlights similar evidence that factors such as policy content or design, partial integration, and poor coordination are some of the factors that negatively shape optimal policy implementation [ 37 – 40 ]. Therefore, it is important to ensure that policies are well-designed and fully integrated, and coordination among stakeholders is strengthened to ensure successful delivery of the CSE framework.…”

Empowering Futures: Intersecting Comprehensive Sexual Education for Children and Adolescents With Sustainable Development Goals

“…This delay in starting a family can significantly boost their economic prospects and contribute to breaking the cycle of poverty. Consequently, these individuals are better positioned to contribute positively to their communities and the global economy, which aligns with the objectives of SDG 1: no poverty and SDG 8: decent work and economic growth [ 46 - 48 ]. Beyond individual health and gender equality, aligning CSE with the SDGs contributes to broader societal goals.…”