O3+: A sexual and reproductive health and rights programme for tertiary students in Zambia and Zimbabwe

In Zambia and Zimbabwe, tertiary institutions— including universities, colleges, technical and vocational training schools, and other post-secondary institutions—are home to over 582’000 young adults, mostly from the lower middle class of society.

Much progress has been made in providing information on sexual and reproductive health and rights (SRHR) during adolescence. However, due to challenges facing in school delivery of comprehensive sexuality education (CSE) including selective teaching of topics, conservative social attitudes, and insufficiently trained teachers, many young people still enter their twenties without adequate knowledge. This places them at an elevated risk for unintended pregnancies, sexual abuse and other negative outcomes.

These young adults face multiple challenges including sexual abuse and violence, peer pressure and economic challenges which often result in their engagement in risky and transactional sexual relationships with severe consequences on their sexual and reproductive health outcomes. A lot of tertiary institutions do not offer a comprehensive health approach that incorporates the SRHR needs of students. On the other hand, only a few have fully functional and equipped clinics. Those that do offer SRHR services struggle with other issues like opening hours, commodity shortages or confidentiality concerns. The situation has only been worsened by the emergence of COVID-19 and its numerous effects.

However, due to challenges facing in school delivery of comprehensive sexuality education (CSE) including selective teaching of topics, conservative social attitudes, and insufficiently trained teachers, many young people still enter their twenties without adequate knowledge.

O3+ as expansion of the Our Rights, Our Lives, Our Future Programme

SDC targets support to this cohort of young people in partnership with UNESCO, and in collaboration with other UN organisations, the Ministries of Higher Education, Campus Health Facilities, Civil Society Organisations, SADC Secretariat, and Tertiary institutions’ communities. The project O3+ expands the reach of the UNESCO’s existing Our Rights, Our Lives, Our Future (O3) Programme, which started in 2018 and supports CSE and SRHR service provision in primary and secondary schools and teacher training colleges. It has strengthened the delivery of quality CSE in 33 countries and helped to develop the skills, knowledge, attitudes and competencies required to prevent HIV, reduce early and unintended pregnancies (EUP), and address gender-based violence (GBV). Now, the project - in its adapted version - is expanded to Higher and Tertiary Education Institutions (HTEIs). The project O3+ seeks to ensure that young people aged between 18-24 years realise positive health, education and gender equality outcomes through sustained reductions in new HIV infections, unintended pregnancy and gender-based violence.

In order to achieve institutional strengthening O3+ facilitates the development and/or adaptation of a CSE curriculum framework to become a compulsory component for all students across all faculties.

By 2025, the project aims to reach over 108’000 students in person or online with accurate, rights-based CSE, to train over 160 healthcare providers and 4’000 peer educators on youth-friendly SRH service provision and to ensure that 70% of the students have been tested for HIV.

Before starting the project, a baseline study for Zimbabwe and Zambia and health facility assessments of 24 HTEIs in both countries (12 in Zambia and 12 in Zimbabwe) were made. The baseline study, which reached 3’876 students, compiled comprehensive information on health service delivery within the HTEIs and collected quantitative and qualitative data, which have been used to establish output indicators and detailed targets for the project. By 2025, the project aims to reach over 108’000 students in person or online with accurate, rights-based CSE, to train over 160 healthcare providers and 4’000 peer educators on youth-friendly SRH service provision and to ensure that 70% of the students have been tested for HIV.

The four main outcomes of the O3+ Programme

1. to support the institutionalization of CSE, SRHR services, and GBV prevention/response in HTEIs (institutional strengthening);
2. to build and strengthen the capacity of campus health facilities to offer a trusted standard package of youth-friendly health services for students (student health and well-being);
3. to support the development, implementation, and effective enforcement of laws and policies to protect students from GBV (Safe and inclusive campus) and
4. to strengthen evidence on CSE and SRHR in HTEIs (Evidence-building and knowledge-sharing).

In order to achieve institutional strengthening (1.), O3+ facilitates the development and/or adaptation of a CSE curriculum framework to become a compulsory component for all students across all faculties, it trains college and university lecturers in CSE and supports the distribution of standard resource package and induction events. It reviews and develops institutional policies on student welfare including policies on GBV and sexual harassment. In order to reach this outcome, a mobile application was developed together with students (Own-u for Zambia and Future+ for Zimbabwe) to ensure students have adequate information on SRHR, professional counselling as well as a helpline for emergency situations.

In order to reach this outcome, a mobile application was developed together with students (Own-u for Zambia and Future+ for Zimbabwe) to ensure students have adequate information on SRHR, professional counselling as well as a helpline for emergency situations.

The programme facilitates policy dialogue between students, policy makers and college authorities on key issues identified.

For student health and well-being (2), the programme seeks to increase SRHR service uptake by training healthcare workers to provide youth friendly services, by renovating health facilities to offer a more appealing and youth-friendly environment, by establishing mobile health services to provide family planning, STI screening, HIV self-test on campus and by training peer educators to disseminate CSE and SRHR information to students, among others.

In order to create safe and inclusive campus environments (3), the programme raises awareness on GBV and EUP by training students, academic staff and campus security staff on identifying, reporting and responding to GBV, by supporting students to create podcasts, radio shows and social media messages, by empowering so-called O3 ambassadors to disseminate messages on GBV, EUP and SRHR, among others. It also strengthens institutional complaint and referral pathways and whistle-blower protection on sexual harassment and GBV.

For evidence-building and knowledge-sharing (4.), the programme conducts research studies on HIV/STI and GBV burden in HTEIs and the overall context for SRHR-related activity and service utilization and it facilitates policy dialogue between students, policy makers and college authorities on key issues identified. It also fosters a culture of knowledge sharing between the HTEIS and finally, it supports institutions to develop a functional information system (databases, health records, surveys, monitoring) for O3+ disaggregated statistics reporting

While the first phase of O3+ takes place in Zambia and Zimbabwe with SDC’s support, the UNESCO’s programme is scaling up to include Kenya, Tanzania (phase 2), Namibia, Rwanda, South Africa and Uganda (phase 3).

In just one year, the number of students taking an HIV test jumped from 8,851 to 16,304. Lastly, to enhance campus safety, over 74,600 students received training on GBV, including sexual harassment.

Significant advances since the start of the programme

The O3+ programme has empowered nearly 72,000 students with the knowledge and skills to navigate their sexual and reproductive health (SRH) through rights-based comprehensive sexuality education courses. This investment in education goes hand-in-hand with innovative service delivery methods. The development of a mobile application, the use of mobile health units and the renovation of 18 campus health facilities have significantly increased SRHR service uptake among students. This is evident in the staggering 84% increase in HIV testing among students from 2022 to 2023. In just one year, the number of students taking an HIV test jumped from 8,851 to 16,304. Lastly, to enhance campus safety, over 74,600 students received training on GBV, including sexual harassment. This training, coupled with standardized policies developed with UNESCO's technical assistance, empowers students to identify, report, and respond to GBV cases through established reporting mechanisms.