British Academy: The UK's National Academy for the Humanities and Social Sciences
14TH BRITISH ACADEMY POSTDOCTORAL FELLOWSHIP SYMPOSIUM
Abstract
Are schools a good setting for adolescent sexual health promotion in rural Africa? A qualitative assessment from Tanzania
Dr Mary Plummer
African adolescents are at high risk of poor sexual health, including HIV infection. Given very limited infrastructure and funding, school systems provide a rare opportunity for sexual health programmes to reach large numbers of young people. However, little research has explored what factors might facilitate or hinder large-scale school programmes. This qualitative study examined pupils', recent school leavers', parents' and teachers' views and experiences of rural Tanzanian primary schools, focusing on the implications for sexual health programmes. It also included a process evaluation of the MEMA kwa Vijana (MkV) sexual health programme, which was implemented in 62 primary schools in rural Mwanza, Tanzania from 1999 to 2001. The study found that half of Year 7 pupils were 15–17 years old, and few went on to secondary school, suggesting that primary schools may be the best venue for such programmes in Tanzania. However, serious challenges included low enrolment and attendance rates, very limited teacher training, little access to teaching resources, and official and unofficial practices which may alienate pupils and their parents, e.g. corporal punishment, pupils being made to do unpaid work, forced pregnancy examinations, and some teachers' alcohol or sexual abuse. Intervention developers need to simplify their subject matter, introduce alternative teaching methods, help improve teacher– pupil relationships, and closely supervise and appropriately respond to undesired practices. The MkV programme attempted to achieve these goals. It was a teacher-led and peer-assisted curriculum based on the Social Learning Theory. Most teachers taught the curriculum content well, but sometimes had difficulty adopting active-learning and inquiry-based teaching techniques. Peer educators performed scripted dramas well, but were very limited as informal educators and behavioural models. The intervention appeared successful in addressing some cognitions, e.g. knowledge of risks and benefits of behaviours, but not others, e.g. perceived self-efficacy to reduce risk behaviours, and perceived susceptibility to risk. In addition to more intensive training for teachers and peers, school programmes may be more effective if they begin in earlier school years, include activities which personalize risk more, focus on the common practice of material exchange for sex, and are integrated within broader, community-wide interventions.
Dr. Mary Plummer is a British Academy Postdoctoral Fellow and Lecturer in the Department of Epidemiology and Population Health, at the London School of Hygiene and Tropical Medicine (LSHTM), University of London. She was the Social Science Coordinator for the MEMA kwa Vijana adolescent sexual health trial in Mwanza, Tanzania from 1999-2002. She is currently analysing the trial's large qualitative database, and writing the manuscript for a book with the working title: Ignoring AIDS in Rural Africa: Young People's Lifestyles and Sexual Health in Tanzania. She has recently published papers in Health Education Research, Children and Youth Services Review, and Studies in Family Planning (forthcoming).