By:By: Fikru TessemaFikru Tessema

Advisors:Advisors:Dr Mirkuze Wolde (MD, MPH)Dr Mirkuze Wolde (MD, MPH)

Mr Yohannes Dibaba ( BSc, MA)Mr Yohannes Dibaba ( BSc, MA)Dr Frehiwot Brehane (MD, MPH)Dr Frehiwot Brehane (MD, MPH)

20 May 2008

1

1. Introduction

2. Problem statement

3. Program objectives

4. Evaluation Questions

5. Objectives of the Evaluation

6. Theoretical Framework of Evaluation

7. Evaluation Methods

8. Evaluation Results and Discussion

9. Limitations of the Evaluation

10. Conclusion and Recommendations

2

School-based ARH education programs generally

have considerable role:

◦ By providing information on :

reproductive health and sexuality,

STIs/HIV/AIDS transmission and prevention and

avoiding pregnancy

◦ By transferring knowledge on:

decision making and

refusal skills for adolescents.

3

The existing young people RH related education

programs in different parts of the country are:

◦ attempting to address RH issues of the in- and out-of school

youths.

This attempt includes a variety of RH activities such as:

◦ community-based RH including youth centers,

◦ school-based RH related education that also include peer

education and

◦ training on RH for health care providers and teachers

4

RH related education programs in the SNNP region are

carried out by public sector and NGOs.

Public sector:

◦ Regional health bureau,

◦ city health departments and

◦ health facilities are participating in RH related education

for in-school adolescents

5

NGOs sector:

◦ FGAE youth centers and

◦ faith-based organizations are also participating in RH

related education.

About one third (33.3%) of high schools in Awassa

City promote RH related education

6

Due to various reasons referred to culture and religion:

o there is no openly discussing issues related to RH in Ethiopia.

This cultural unwillingness and embarrassment is

barrier:

o to adolescent RH education programs promotion in-and out-of

schools in the country.

As a result, most adolescents lack:

◦ how RH problems occurs and

◦ how to prevent RH problems

7

The objectives are:

◦ To reach in-school adolescents with knowledge and

skills needed to foster and sustain health-affirming

behavior.

◦ To increase access and utilization of adolescent

reproductive health services in school.

8

1. How in-school adolescents were reached with RH education in schools?

2. What extracurricular activities related to RH education were carried out in schools?

3. How ARH services were linked to ARH education in schools?

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(1) General Objective

The overall objective of this evaluation is to assess how

adolescent RH education is carried out in high schools in

Awasa City.

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(2) Specific Objectives

2.1. To assess the enrollment status of adolescents in RH

education in high schools.

2.2. To assess the implementation status of

extracurricular activities carried out in relation to

adolescent RH education in high schools.

2.3. To assess the status of linkage between adolescent

RH education and adolescent RH services.

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Program products:In-school adolescents reached with RH education, training of educators and health information on RH services

Program activities: - RH education in schools - RH related extracurricular activities - HI on RH services and providers

ARH education program & its context:- Program stakeholders, - Legal framework,

Program inputs: Program funds, HR, strategy, standards, IEC/BCC materials, HFs

Retain interventions

or

take corrective measures

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Study area and Study area and periodperiod

Conducted in Awassa town, South Ethiopia from 23 September to 08 October 2007

Two high schools from six high schools included trough purposive selection with a total of 2925 students in grades 9 and 10

Study design Study design and techniqueand technique

A case study method with both qualitative in-depth interview and quantitative survey

Source Source populationpopulation

All health professionals in the Regional Health Bureau, Awassa City Administration Health Department, Awassa Health Center, and FGAE branch office

All students and teachers in high schools in Awassa city

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Sampling Sampling techniquetechnique

Two high schools have been selected purposively for surveying of students, and

Surveying of all Biology teachers teaching in grade 9 and 10

Sample sizeSample size Sample size for student survey was calculated by using EpiInfo and assigned to each school based on their student population in grade 9 and 10 and

for each student from each section by using MS Excel randomly generated from sampling frame.

Regional HB, Local Authority, Model Youth centers and HFs were selected for in-depth interviews of experts.

15

Aawasa & Addis Ketema High

SchoolsAwasa FGAE

Branch Office

Clinic(HC)

Youth Center(H&YC)

Awassa City Health

Department(DPCC)

Awassa Health Center(MCHC)

SNNP Regional Health Bureau

(FHE)

Biology teachers

Students in grade 9&10

Public sector NGO sector

Methods … (cont’d)Methods … (cont’d)

Inclusion criteria: Schools provided with adolescent RH education,

Adolescent RH service providers and

Program managers have been included in the study.

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Data collection instrument

Method of data analysis

Unit of analysis

Quality control

IDIs guide Thematic and content analysis

Program managers & Service provider(experts)

Presented to participants for comment on draft report

Closed-ended self administration questionnaires translated to Amharic

Descriptive using EpiInfo & SPSS software: for data cleaning, frequency table, uency table, cross tab, graphscross tab, graphs

Schools(teachers, students)

Pre-test, Training, Supervision, Double data entry and Meta Evaluation:⁃ utility, ⁃ feasibility, ⁃ accuracy and ⁃ propriety standards

Ethical clearance obtained from:

◦ Jimma University and

◦ SNNP Regional Health Bureau Research and Laboratory

Department

Confidentiality:

◦ Participants’ identities protected and respected

Informed consent:

◦ verbal consent with signed consent form by data

collectors

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1. Socio-Demographic Characteristics of the 1. Socio-Demographic Characteristics of the

respondentsrespondents

A total of 436 in-school adolescents were

participated in student survey:

with the response rate of 95.0% of the 458 calculated

sample size,

of which about 61.7% were male and 38.3% female in-

school adolescents.

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Of all Biology teachers, 16 participated in teacher

survey:

o with 94.1% response rate,

o of which about 11 were male and 5 female teachers.

A total of 6 in-depth interviews have been

conducted:

o with the experts, of which 5 were male and 1 female.

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2. 2. Provision of RH education for adolescents in high schools:Provision of RH education for adolescents in high schools:

The majority of the respondents to student survey: ◦ 84.4% reported that they were being taught RH

education in schools.

◦ 83.0% also reported having RH related education sessions some times.

◦ In IDIs, it was found that there was no regular session for ARH education in schools. Hence, it was not included in school-time table.

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Of the total respondents to teacher survey:

12 teachers (9 males & 3 females) were comfortable

with teaching adolescent RH education.

All respondents to IDIs also explained that:

they use the National RH strategy to facilitate the

provision of adolescent RH education in schools.

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Type of topics included in ARH education in high schools

Respondents

Yes %

HIV/AIDS 281 76.4%

Pregnancy 239 64.9%

STIs 178 48.4%

Abortion 113 30.7%

Communication skill 87 23.6%

Concept of RH 61 16.6%

Physical and social development 52 14.1%

Negotiation skills 32 8.7%

Harmful traditional practice 5 1.4%

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3.3. Extracurricular activities related to ARH education Extracurricular activities related to ARH education

in schoolsin schools

A student survey revealed that:

65.4% of the total respondents participated in

extracurricular activities like health, drama, mini media

clubs and IEC/BCC on RH.

There are some initiatives explained by IDIs respondents:

• with regard to extracurricular activities related to ARH

education in schools

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Among some initiatives:

◦ training of peer RH services providers

◦ out-reach RH education

◦ peer educators and teachers training in RH

◦ drama and music show

◦ Youth dialogue (new initiative initiated by FGAE Model

Youth Center), and

◦ adolescent RH IEC/BCC

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One of the IDIs respondents said,

◦ “…the IEC/BCC materials supplied to high schools and

NGOs were too small amount,

◦ it cloud not reach all in-school adolescents because they

are many in number.”

With regard to the distribution of IEC/BCC materials on RH,

about 38.8% of respondents to student survey have got

chance of reading the materials

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4.4. Linkage between ARH education and ARH services Linkage between ARH education and ARH services

In this regard, most of the respondents to a student

survey:

◦ 84.2% had information about RH services and RH service

providers.

◦ In which health facilities (78.2%) were the most commonly

mentioned RH service providers.

Most IDIs respondents also explained that there have been

◦ counseling for RH problems and

◦ referral for RH services in schools for adolescents.

27

28

Soursces of Information on RH cited by Adolescents

160

77

94

78

167

100

8

0

20

40

60

80

100

120

140

160

180

Health club inschool

Teachers in school Peers in school Parents Mass media Health workers Others (OSY,NGOs, etc)

Soursces

No

of

Resp

on

den

ts

(45.5%)(45.5%)(43.6%)(43.6%)

(27.2%)(27.2%) (25.6%)

With regard to RH problems of adolescents, about 94.5% of

the total respondents thought that adolescents faced RH

problems.

An 18 years old male 10th grade student, he made a

comment in relation to RH problems, for which they need

RH services,

◦ The direct Amharic version of his comment says, “… “… እኛ እኛ

ኢትዮጵያዉያኖች በኢኮኖሚ ሳይሆን በህዝብ ብዛት ነዉ እየተወዳደርን ያለነዉ ይህን ኢትዮጵያዉያኖች በኢኮኖሚ ሳይሆን በህዝብ ብዛት ነዉ እየተወዳደርን ያለነዉ ይህን

…”ገጽታ ቀይሩልን እኛም እንታገላለን …”ገጽታ ቀይሩልን እኛም እንታገላለን

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Matrix of analysis for judgment:

◦ A template was developed with the consultation of

stakeholders and

◦ set weights and standards (cut-of points) for each

program activity.

◦ Findings for each program activity were compared with

standards (cut-of points) to declare the level of

achievements based on parameters for judgment.

30

In this evaluation it is evident that RH related education

provision in high schools was found to be adequate in

reaching most adolescents (84.4%)

With regard to extracurricular activities like the distribution

of IEC/BCC materials on RH was inadequate

◦ about 38.8% of respondents to student survey have got

chance of reading the materials.

31

There was also few new initiatives to involve adolescents in

RH issues to cope up with the needs of adolescents.

The provision of HI and education on adolescent RH

problems was found to be successful in getting the majority

(94.5%) of the respondents to think that adolescents can

face RH problems.

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The availability of health information dissemination in-school on

RH services providers:

◦ was found to be adequate to link RH education with RH

services (84.2%)

◦ in which most (78.2%) of the respondents to student survey

cited at least health facilities as ARH services providers.

This was also comparable with a study done in eight regions of

Ethiopia:

◦ in which about 72.0% respondents were reported health

institutions as places for ARH services.

33

This evaluation:

◦ was done in two high schools of Awassa town, which

may not represent other high schools in the country.

34

The overall provision of RH related education in high

schools was fair

The overall participation of adolescents in

extracurricular activities related to RH education in

schools were achieved fair results

The provision of counseling, HI and education on RH and

sexual issues was also successful

35

New initiative like youth dialogue:

◦ important entry point to encourage adolescents

◦ in discussing and finding out healthy ways of dealing

◦ with RH problems by themselves.

36

In the findings of this evaluation, it is evident that there

have been activities to be:

◦ improved ,

◦ retained and

◦ included in adolescent RH education programs in high

schools.

37

Need for improving performances

Outreach RH education in high schools by Awassa city

health department and youth center:

◦ has to be carried out on a regular schedule

◦ to achieve consistent fostering of knowledge and skills to

adolescents.

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Strengthening extracurricular activities:

◦ such as school health clubs and training in RH by

providing refreshers courses for club members by

targeting peer educators and teachers, and

◦ mini media with the supply of audio-video equipments

and CDs through the Regional Health Bureau

Need for retaining best performances

The provision of counseling, HI and education on RH and

sexual issues has to be sustained

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Need for including initiatives

New initiative like youth dialogue should be included in

youth friendly RH service standards. Hence, the Federal

MoH should revise its youth friendly RH service standards

40