Adolescents’ Health in Adolescents’ Hands

Health challenges faced by the Adolescents in Ulanga

The greatest risk factors for adolescent health are poor sexual and reproductive health and rights including sexually transmitted infections, malnutrition and anemia, substance abuse, mental health concerns, teenage pregnancy and violence including gender-based violence. All these health-related outcomes are exacerbated in adolescents growing up in rural areas of the country. At project start, adolescents in Ulanga confirmed these challenges. In addition, they expressed a lack of access to services and health information.

In 2013, Tanzania signed up to the Ministerial Commitment on comprehensive sexuality education and sexual and reproductive health rights and services for adolescents and young people in Eastern and Southern Africa. The government is committed and is investing, however, health education for adolescents in rural Tanzania still faces several constraints.

Peer education is an integral part of Tanzania's health education strategy but faces challenges due to the lack of well-trained peer educators, who need to strengthen their knowledge of health topics and improve their skills in sharing it.

SRHR education challenges

Peer education is an integral part of Tanzania's health education strategy but faces challenges due to the lack of well-trained peer educators, who need to strengthen their knowledge of health topics and improve their skills in sharing it. That was observed in 2022 during the initial assessment of health education session carried out by Enfants du Monde and SolidarMed that showed among other results that peer educators often deliver knowledge in an expositive way rather than involving the person in learning it, hindering sustained behavioral change.

The aim is to empower peer educators to effectively transfer knowledge and life skills to their peers.

Although some adolescent sexual and reproductive health and rights information is provided in schools, facilitators don’t always have the capacities to explain these issues, SRH being a sensitive subject. Moreover, sociocultural norms may hamper adolescents from discussing health issues with grown-ups.

When providing SRH education, it is challenging to navigate effectively between national regulations, educational institutions and community settings. Besides, some trainers may harbor subjective perspectives regarding curriculum content selection. All this makes it difficult to answer to the real needs of adolescents.

Providing SRH knowledge tailored to their needs and context through an enhanced training chain will contribute to behavioral changes of adolescents, so they can live healthy lives and be motivated to use SRH services.

How It All Began

SolidarMed started working in Ulanga District in 2007, implementing interventions within the existing health system in close collaboration and coordination with the Council Health Management Team of Ulanga, the health institutions, the departments for education, community development, and social welfare and the communities. Joining their expertise, in 2021, Enfants du Monde and SolidarMed developed a common project to address the identified challenges of adolescents.

While SolidarMed is improving access to ASRH services in an adolescent friendly way through a combination of interventions at health facilities and communities, Enfants du Monde is reinforcing the capacities of adolescent peer educators, teachers, and community health workers to provide quality SRH education. AHA! project applies a comprehensive approach in addressing the two key challenges of adolescents in this context: access to services and access to information.

Same peers, new methodology: applying quality education to health sessions

Enfants du Monde has developed a quality education approach where knowledge is built through contextualization of content (meaning that knowledge is related to learner’s context) and active pedagogy to empower individuals in their lives. These two principles contribute to putting adolescents at the center of the educational process, starting from their needs and interests and the sociocultural context.

The hypothesis is set on a belief that interactive and interesting education sessions, that consider learners’ opinions and encourage their participation, also based on reflections on their experiences and context, will promote their engagement in learning process and thus result in actual behavior changes.

The aim is to empower peer educators to effectively transfer knowledge and life skills to their peers. We enhance the pedagogical aspects and establish procedures for conducting health sessions. The proposed educational method starts with letting adolescent identify the health problem and express their knowledge through a real-life situation. Then the expected knowledge is provided to generate attitudes and practices favorable to their health. Finally formative assessment is suggested, and adolescents are also invited to use acquired knowledge to create health messages with their own words. Those messages will be transformed into mini-pedagogical projects to disseminate into communities so that the adolescents can be actors of change. Thus, health knowledge is built up throughout the session in different ways.

Involving all levels of the training chain to achieve better results

The training chain involves a wide range of actors: the Ministry of Health and the Ministry of Education, local government officials, national trainers, teachers, healthcare providers, community health workers and, of course, adolescent peer educators. The involvement of all these actors ensures comprehensive support and guidance throughout the peer education training process even if it requires substantial investment in terms of human resources, time and funding.

Despite these challenges, we expect to witness durable transformative outcomes at various levels of the training chain, resulting in better-informed adolescents regarding their SRHR. Providing SRH knowledge tailored to their needs and context through an enhanced training chain will contribute to behavioral changes of adolescents, so they can live healthy lives and be motivated to use SRH services; the quality and availability of which are equally strengthened within the project.

Following the initial assessment carried out in 2022, we developed a user-friendly facilitation guide for peer educators based on the content of the Tanzanian National guidelines. The facilitation guide provides detailed instructions on how to run the educational sessions by integrating the key principles of quality education.

Achievements so far

Following the initial assessment carried out in 2022, we developed a user-friendly facilitation guide for peer educators based on the content of the Tanzanian National guidelines. The facilitation guide provides detailed instructions on how to run the educational sessions by integrating the key principles of quality education.

In 2024, we experimented our educational material with a small sample of peer educators, in and out of school. We also conducted a Knowledge, Attitude and Practice (KAP) survey among 500 adolescents as a baseline before we start the training sessions. Midline and endline KAP surveys will then measure the outcome of the intervention on adolescents’ attitudes and behaviors and will orient us on how to address their needs. In addition, monthly supportive supervision will be provided to guarantee the quality of education sessions.

First results of experimentation are encouraging. We already see an increased knowledge among peer educators who have been trained in the new educational methodology and in the capacities to animate health education sessions, in a way that it is more participatory. Adolescents showed improved skills of critical thinking with regard to SRH issues in their context.

This new educational approach will be implemented in Ulanga District, ultimately covering approximately 44’000 adolescents 10 to 19 years. Buy-in from the Ministry of Health (MOH) was obtained through close dialogue and involvement from the start. At a later stage, this will facilitate validation of the material developed and use on a wider scale.

References

• Barriers to Secondary Education in Tanzania, Human Rights Watch, 2017. https://www.hrw.org/report/2017/02/14/i-had-dream-...
• Demographic and Health Survey Tanzania 2022 https://dhsprogram.com/pubs/pdf/PR144/PPR144.pdf
• Ministry of Finance and Planning, Tanzania National Bureau of Statistics and President’s Office – Finance and Planning, Office of the Chief Government Statistician, Zanzibar. The 2022 Population and Housing Census: Age and Sex Distribution Report, Key Findings, Tanzania, December 2022.
• National Adolescent Health and Development Strategy 2018-2022; Ministry of Health, Community Development, Gender, Elderly and Children. https://tciurbanhealth.org/wp-content/uploads/2017...
• Vygotsky, L. S. (1934a). Vygotsky’s Social Constructivists Theory of Learning. 5(2002), 2–7.
• WHO: Maternal, newborn, child and adolescent health and ageing. Data portal. https://platform.who.int/data/maternal-newborn-chi...