By Elizabeth Williams

At the International Conference on Population and Development (ICPD) in 1994, the governments’ present made commitments to promote the Sexual and Reproductive Health of Adolescents through policies and programmes. Twenty years on, Adolescent Sexual and Reproductive Health (ASRH) policies and strategies are in place in many countries. Although, some countries efforts are underway, there are concerted government led efforts to provide sexuality education and user-friendly services to adolescents.

On Monday the 4^th of April – 6^th of April 2016, I was opportune to attend a “Global consultation to draw out lessons learned from the first generation of scaled up adolescent Sexual and Reproductive Health programmes” which was held at the Ecumenical Centre in Geneva, Switzerland.

In attendance were major players and experts in the field of Adolescent Sexual and Reproductive Health which included representations from about 14 low and middle income countries who have achieved the first generation of scale up programming, International Non-governmental organizations, representatives of Bi-Lateral agencies and Foundations, United nations Agencies, Academics and World Health Organisation(WHO).

The main focus of the meeting was to draw out lessons learned from the first generation of scaled up Adolescent and Sexual Reproductive Health programmes – both programmatic achievements as well as challenges experienced. During the Consultation, countries made presentations on different areas and themes which were vital ingredients in scaling up as well as window opportunities, support and resistance, scale-up approach, players, resources, sustainability, unravelling, quality and equity.

Nigeria was definitely not exempted as we made 2 presentations; “Windows of Opportunities” by Mrs. Adenike Esiet, Executive Director of Action Health Incorporated on the 1^st day. In her presentation, she highlighted some of the factors that led to windows of opportunities in scaling up Comprehensive Sexuality Education in Nigeria. This was as a result of overwhelming evidence of lack of access to comprehensive sexuality education and this was evident in the high rate of young persons infected with HIV/AIDs, teenage pregnancy, unsafe abortion, among other challenges.

Not only was there an overwhelming evidence of need, there was also a strong community of lead CSOs Advocating for Comprehensive Sexuality Education Policy. They played a great role  in ensuring ASRH as government support especially in terms of fund was minimal as the project relied mostly on external donors and funders such as MacArthur Foundation; Packard; Ford; UNFPA; DFID, and The Global Fund in providing long term investment. They successfully had a National Policy that allowed CSE integration into school curriculum in secondary schools in Nigeria in 3 basic subjects, Social Studies, Integrated Science and Civic Education.

Another presentation was given on the “Players (who played key roles in the scale up effort?)” of Comprehensive Sexuality Education in Nigeria on the 2^nd day by me. In my presentation I talked about the key players and major stakeholders who contributed to the scaling up of CSE in Nigeria. Some of these players include:

1. The National Council of Education (Nigerians Education Policy Organ) whose main role was the National Policy Pronouncement mandating CSE integration into school curriculum and having an Annual Forum for reporting progress and challenges with FLHE implementation by federal and state ministries of education.

2. Youth and reproductive health non-governmental organizations (YRH-NGOs): Action Health Incorporated; Girl Power Initiative; Awareness Research Foundation; HIV Prevention for Rural Youth. They provided teacher in-service training on the FLHE curriculum and ongoing support to schools; Implementation and evaluation, Monitoring, Building evidence and advocacy for policy and program implementation.

3. The National Education Resource Development Council; Federal Ministry of Education and Action Heath Incorporated. They developed the CSE Curriculum and implementation guidelines of the curriculum so as to ensure uniformity in all of the states in Nigeria.

4. National Commission for Colleges of Educations / Teacher training Institutes. They Provided Pre-Service Training and on-going monitoring at pre service levels

From all of the presentations by the different countries, it was evident that in the Scaling up of Adolescent Sexual and Reproductive Health, young people need and have to be actively engaged from the beginning in the scale-up vis a vis planning, research, programme, implementation and monitoring and evaluation.

Despite the considerable progress made towards the Millennium Development Goals related to health, we are still failing adolescents. Why? Because we cherish myths and impose adult values and this is evident in our health care systems that serve adults and small children better than the adolescents.

Moving forward, we realize that a lot has been done and still need to be done in providing Comprehensive Sexuality Education (CSE) to adolescents in Nigeria with support and assistance from Non-governmental organizations like Action Health Incorporated and government ministries like the Ministry of Education. We need to scale up our Youth Friendly Health Services (YFHS) because both CSE and YFHS are essential, CSE generates demand and YFHS provides Supply, One cannot work without the other. The Government need to wake up to their responsibility by providing funds to make this a reality, NGOs and civil societies need to work together in ensuring that adolescents are provided with quality YFHS.

And most importantly, young people need to be actively engaged as I said earlier from the beginning. It is the right of young people to assess youth friendly health services, but how can that right be exercised if there are no facilities and structures put in place? Hence, structures should be put in place for adolescents to be able to exercise their rights to access YFHS. Also the Youth friendly service providers should be friendly and approachable to young people, confidentiality should be guaranteed, and lot of advocacy should be done so that adolescents can be aware of these services and use them. Most importantly, the services should be affordable for young people.

Finally, it’s high time that we start training young leaders and not just peer educators because the future of the world rests on the shoulders of this 1.8 billion young people. Geneva was fun, educating, and full of lessons to bring back home with lots of opportunities to explore. One would say what were the lessons learned, well let me enlighten you; In scaling up Comprehensive Sexuality Education and Youth Friendly Services, you need to take the following into cognizance:

• Learn to seize current global window of opportunities and exploit local opportunities which could be policy, finance or even political commitment.
• Make sure you ensure strong links with local and national media, opinion leaders, religious and cultural leaders from the start.
• Use sensitive and acceptable name for CSE, like in Nigeria, it is called Family life and Health Education (FLHE)
• It is highly important to develop both horizontal and vertical scale up simultaneously as opportunities arise
• Undertake regular monitoring and evaluation to adjust programming as needed and show results.
• Link! Link!! Link!!! CSE and YFHS scale up as much as possible, it not over emphasized enough as this was something everyone present at the consultation agreed was lacking in most of the scale ups.
• Always engage youths as active participants from the start, they have a key role to play.
• Undertake full costing before scaling up, with assessment of requirements for all aspects of the scale up, also learn to exploit both traditional and new funding sources. The watch word here is “Do less well, rather than more poorly”.
• For sustainability, National and local ownership are very important especially in ensuring a successful scale-up.
• Always develop a contingency plan and tool to use in the event of threatened programme collapse.
• Most times in scale up, the marginalized and vulnerable are not identified and are left out, this needs to be corrected, they need to be identified from the start to ensure equity during scale up.

It’s an experience worth reliving. What I tell young people is this, “what mark or imprint would you leave on the sands of time when you are gone?”

KEY WORDS

ASRH – Adolescent Sexual and Reproductive Health

CSE – Comprehensive Sexuality Education

YFHS – Youth Friendly Health Services

Disclaimer

This article is solely the views/opinions of the writer and does not necessarily represent those of AHI. AHI will not accept any liability in respect of this communication, and the writer responsible will be personally liable for any damages or other liability arising.