The Eastern and Southern African Ministerial Commitment on Comprehensive Sexuality Education and Sexual and Reproductive Health Services for Adolescents and Young People
"Eastern and Southern Africa (ESA) has 158 million young people aged 10-24; a number that is expected to rise to 281 million by 2050. Better education and public health measures will be hugely beneficial to the health and development of these young people."
In 2013, Ministers of Education and Health from 20 countries in Eastern and Southern Africa (ESA) agreed to work collaboratively towards a vision of young Africans who “are global citizens of the future, who are educated, healthy, resilient, socially responsible, informed decision-makers, and have the capacity to contribute to their community, country, and region”. They affirmed a commitment to the right to the highest possible level of health, education, non-discrimination, and well-being of current and future generations and agreed on two sets of targets to be achieved in 2015 and 2020 respectively. This report, published by the Young People Today initiative which represents this regional ministerial commitment, presents the progress made after two years of implementation (2013-2015), as well as the barriers and challenges that remain for all targets for 2020. The data presented was obtained and validated through a multi-sectoral country reporting process as stipulated by the respective coordination mechanisms of the ESA Commitment. Overall the results for 2015 are positive with milestones for the first three targets having been met and exceeded, which, according to the report “proves that with targeted interventions, sound strategies, adequate resources, and political will, the ESA Commitment targets are attainable.”
Following a discussion of the ESA Ministerial Commitment and its coordination and management, the report offers a regional synthesis of the progress and results related to each target following two years of implementation (country specific progress is presented in the appendices). The discussion also highlights innovations and promising practices from individual countries though "spotlight" case studies related to each target. The following is just a brief overview of some of the findings (Note related to results: Although Rwanda did not attend the initial meeting where targets were agreed upon, Rwanda has been, and continues to be, a part of the ESA Commitment process and has produced a country report, bringing the number of countries reporting to 21) :
Target 1: A good quality comprehensive sexuality education (CSE) curriculum framework is in place and being implemented in each of the 20 countries by 2015
Results show that 15 out of 21 countries report providing CSE/Life Skills in at least 40% of primary and secondary schools. However, “while most countries now include CSE in the curriculum, a number of countries are yet to fully integrate CSE at scale, as this often happens in the context of a wider curriculum reform. Where CSE has been largely scaled-up, there is still a need to strengthen the quality of delivery to ensure that core essential topics are included and are taught early (before sexual debut). Furthermore, there is a need to strengthen programmes reaching those not enrolled in school.”
Target 2: Pre- and in-service SRH and CSE training for teachers, health and social workers is in place and being implemented in all 20 countries
All 21 countries report having CSE training programmes for teachers. 17 out of 21 countries report having youth-friendly SRH service training programmes for health and social workers. As stated in the report, "[i]mproving efforts to capacitate teachers to transfer knowledge and skills using effective teaching practices remains a priority. More work is needed to ensure that training material for health workers is fully aligned to WHO [World Health Organization] standards and are instituted within health ministries."
Target 3: By the end of 2015, decrease by 50% the number of adolescents and young people who do not have access to youth-friendly SRH services, including HIV, that are equitable, accessible, acceptable, appropriate and effective
Results show that 15 out of 21 countries report offering the standard minimum package of adolescent and youth-friendly SRH service. As stated in the report, “[t]he levels of alignment and implementation of national standards according to WHO guidelines vary within and among countries, and recent reviews reveal limited progress on improvements of service delivery, especially to the most vulnerable and marginalized populations. As a result, young people continue to face barriers when accessing SRH services. These include conflicting laws, fear and shame, stigma, negative attitudes of health workers, and lack of knowledge on where and what services are available."
The report then looks at progress related to the 2020 targets, which build on the achievements of the first three targets. The following is a brief overview:
Target 4: Consolidate recent and hard-won gains in the reduction of HIV prevalence in ESA and push towards eliminating all new HIV infections among adolescents and young people
The report notes that although new HIV infections are on the decline across the region, these reductions remain insufficient as significant numbers of young people, predominantly adolescent girls and young women, are still becoming newly infected.
Target 5: Increase to 95% the number of adolescents and young people, aged 10-24, who demonstrate comprehensive HIV prevention knowledge levels
Although young people in the region are more knowledgeable about HIV than a decade ago, the majority of young people still lack sufficient knowledge about HIV transmission and young women are less likely than young men to have accurate and comprehensive knowledge about HIV transmission.
Target 6: Reduce early and unintended pregnancies among young people by 75%
Early and unintended pregnancy rates among adolescent girls aged 15-19 remain high across the region, ranging from 39% in Tanzania to 59% in Kenya. In 2015, there were an estimated 3.3 million live births among adolescent girls aged 15-19 years in East and Southern Africa, a figure which is projected to rise 5.4 million by 2035.
Target 7: Eliminate gender-based violence
Research shows that 1 in 3 girls has been forced to have sex by the age of 18 years. Gender-based violence remains high across all countries and puts girls at higher risk of HIV infection which has knock-on effects on educational and health outcomes for women and children.
Target 8: Eliminate child marriage
Only 6 countries have set the age of consent to marriage at 18 years without exception. The African Charter on the Rights and Welfare of the Child (ACRWC) prohibits the marriage of any child under the age of 18 years. However, in the majority of countries in the ESA region, traditional or customary law continues to support early marriage and more than one third of women aged 20-24 years (6.5 million) have been married or in a union before the age of 18.
In conclusion, the report states that “[T]here has been enormous investment by a range of partners which has led to all 2015 targets being met and exceeded. However, the outcomes in terms of HIV knowledge, behaviour, and GBV will take several years while these initial inputs translate into service delivery and education for all young people. The ESA region can achieve the 2020 targets if there is continued commitment and adequate investments towards adolescents’ and young peoples’ SRHR.” It offers a list of recommendations which are derived from regional and country consultations with ESA Commitment stakeholders, including young people. The following are just a selection:
- “Prioritize increased access to CSE and SRH services for all girls and boys – in and out of school, regardless of marital or pregnancy status – to address the disturbingly low HIV and AIDS knowledge levels among young people and the challenges they still face in accessing SRH services.”
- “Prioritize filling the gaps in knowledge and evidence around adolescents’ and young people’s health, education and rights. To ensure that interventions and resources are well targeted, there is a need to strengthen data collection mechanisms at all levels while ensuring that data is finely disaggregated by sex, age economics status, and geographical location.”
- “There is a need to innovate around the use of different and relevant forms of media (both traditional and digital) to ensure diverse groups of young people are sufficiently connected and continue to be engaged with in the policy-making processes that impact on their lives.”
- “New and effective mechanisms need to be found to reach young key populations and marginalized adolescents, for example those who are living in extreme poverty, married at a young age, sell sex for economic survival, or living with disabilities.”
- “Develop and implement programmes that encourage communities to promote the delay of marriage and pregnancy, including by addressing cultural barriers, traditional laws, and other actions that promote early marriage and pregnancy.
- Mobilize communities to promote egalitarian gender norms, engage men and boys, and end gender-based, sexual, and intimate partner violence.
- Empower parents and guardians to talk to young people about sexuality, their responsibilities, and their rights as early as possible using accurate and appropriate language that they can understand.
- Engage religious and traditional leaders so that they are supportive of all young people accessing good quality CSE and SRH services."
Development Partners and Other Stakeholders
- "Harmonize and coordinate existing programmes targeting young people, such as DREAMS, All In!, and the ESA Commitment to ensure better alignment and more efficient use of resources.
- Support communities and civil society, including youth-led organizations, to ensure increased access to good quality CSE delivered by well trained teachers and mentors."
Young People Today website on January 24 2017.