Skills Based Health Education ~ Additional Case Studies
Zimbabwe - AIDS Action Program for Schools. Zimbabwe has one of the highest AIDS prevalence rates in Africa and young people are particularly at risk from HIV infection and other unwanted effects of unprotected sex. By the age of 19, 44% of adolescent females are either pregnant or have given birth, indicating a high rate of unprotected sex (Ndlovu & Kaim, 1999). In 1992 the Ministry of Education and Culture initiated a Life Skills education program, in collaboration with UNICEF, for schools (AIDS Action Program for Schools). The program is aimed at students and teachers in grades 4-7 in all primary schools, and in grades 1-6 in all secondary schools. It aims to develop pupils’ life skills such as problem solving, informed decision making and avoidance of risky behavior, using participatory and experiential teaching and learning processes.
Over 2000 teachers have been trained (using pre-service and a cascade model of in-service training) and the program is taught in over 6000 schools, with equal status as other curriculum subjects. Supporting textbooks and teaching materials have been developed and the program has the full support of Government and other influential groups such as Churches. (Gatawe, 1995; Gachuhi, 1999).
Challenges for this program include level of teacher training, skills, experience and confidence. A review in 1995 found that only a third of teachers had received any in-service training. Teachers were unfamiliar with life skills participatory and experiential learning techniques. Many found sensitive topics of sex and HIV embarrassing and difficult to teach.
Zimbabwe - ‘Auntie Stella’ Reproductive Health Education. The ‘Auntie Stella’ health education pack for secondary school students was developed following research by the Training and Research Support Centre (TARSC) in their Adolescent Reproductive Health Education Project (ARHEP) as well as drawing on the experience of the AIDS Action program. Using participatory research methodology, the ARHEP program identified knowledge and major concerns of students (e.g. fear of rape and sexual harassment, unwanted pregnancy, lack of money leading to coercive sexual relationships, fear of STDs and AIDS) regarding reproductive health, along with sources of help and information available to the students.
‘Auntie Stella’ is a classroom-based pack consisting of question and answer cards, based on the format of magazine helpline letters (identified by ARHEP as among the chief sources of information for reproductive health for adolescents). This format helps students identify and analyses their behavior, including risk taking behavior and situations. Students then take part in exercises to help them devise ‘Action Plans’ and suggest ways that their behavior could change to reduce risk. ‘Auntie Stella’ has been field tested in eight pilot schools and based on the evaluation and recommendations of this, the program will be expanded to a national level, by taking ‘Auntie Stella’ to other schools throughout the country (Ndlovu and Kaim, 1999).
The initial reaction to the ‘Auntie Stella’ pack by both students and teachers has been positive and encouraging. Expanding the program has the support of the Ministry of Education and Culture. The next phase of program evaluation will concentrate on the impact of ‘Auntie Stella’ on behavior, in areas such as whether the students are actually implementing the Action Plan points developed through ‘Auntie Stella’. Challenges for the program include helping the students devise and practice realistic strategies and skills for avoiding risky behavior.
Lima Peru – HIV/AIDS prevention in secondary schools: A skills based education program on sexuality and HIV/AIDS prevention was designed taking into account Social learning Theory and constructs of machismo and openness towards sexuality. 14 schools were randomly assigned as interventions and controls. The intervention schools implemented seven weekly two hour sessions, which included discussions, verbal exercises, role playing, familiarization with condoms/contraceptives and lectures. Homework promoted interaction with family, friends and local health institutions. Trained teachers from the schools facilitated the program. When compared with the control group, the intervention group showed significant changes in knowledge on sexuality and AIDS, openness towards sexuality, acceptance of contraception, tolerance of people with AIDS, self-efficacy and prevention orientated behaviors (Caceres et al., 1994).
Colombia - Risk factors for adolescents: Life skills training is promoted by the Department of Human Development of the Ministry of Health, as part of a health promotion strategy that addresses some of the most important risk factors of children and adolescents, including school drop out, child labor, early sexual activity and adolescent pregnancies, delinquency, violence and substance abuse. In 1996 Fe y Alegria, an international NGO, began implementation of a pilot project using WHO Life Skills training materials, adapted to a Colombian context. The pilot covered 6 schools in 3 regions (1,260 students, aged 10-15, 500 parents and 45 teachers. The project included teacher training and workshops, extra curricula activities and work with parents. Although full evaluation of the project has not yet been completed, teachers, parents and pupils have indicated initial positive outcomes, including; positive changes in behavior, decreased levels of aggression, greater ability to speak openly and cope with emotions, high degree of acceptance of life skills methods (Meresman et al., 2000).
Vietnam – HIV/AIDS prevention: A skills based HIV/AIDS prevention project was begun as a UNICEF-assisted HIV/AIDS prevention project of the Vietnam Ministry of Education and Training (MOET) in 1997. The project was undertaken in the context of rapid social and economic change in the last decade, with problems in the health sector of access and equity, and a growing concern amongst health officials of the threat of HIV/AIDS. The primary goal of this project was to equip young people with the information and skills needed to make, often difficult, decisions that would allow them to lead healthy lives, especially in relation to HIV/AIDS/STD risk. A pilot life skills teaching approach was implemented in schools, with teachers being trained and supported in skills based health education. The major focus was on student knowledge, attitudes, values and behaviors – with an anticipated outcome that the program would also have a positive impact on teaching staff.
Evaluation at the completion of the pilot phase of the project showed that students demonstrated increased knowledge of HIV/AIDS and its transmission, and increased knowledge of how to avoid infection, improved tolerance and improved decision making skills. Teachers also showed an improved level of knowledge and found that the interactional teaching techniques were a great improvement over more traditional didactic methods. A UNAIDS evaluation of the project also confirmed that there the program was effective for both students and teachers in terms of building confidence, knowledge and abilities. This evaluation also suggested that there was a need to gather future information on student sexual behavior such as contraceptive use, community and national pregnancy rates and rates of STD infection, to evaluate the impact of the project on behavior change (UNAIDS, 2000).
Tanzania - The Lushoto Enhanced Health Education Project: In 1998, the Tanzania Partnership for Child Development carried out a study in the Lushoto district of Tanzania (the Lushoto Enhanced Health Education Project – LEHEP), focusing on worm infection and personal hygiene, involving teacher-led, innovative, active, participatory health education methodology. A randomly selected group of schools was chosen to implement the project and compared with a set of randomly selected schools that were not adopting the LEHEP approach. When results of the program were evaluated, there was good evidence of improved knowledge and practices in the intervention schools, but not in the control schools, particularly with reference to provision of safe drinking water, water for hand washing, general environmental cleanliness and health awareness. At the outset of the project, no schools provided drinking water, or water for hand washing after using the latrine. By the end of the first year all schools in the intervention area were doing both. A follow up survey fifteen months after the end of the project year found that many of the healthy behaviors adopted in the intervention schools were still being maintained (Lansdown et al., 2001).
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