This document summarizes an evaluation of adolescent reproductive health education programs in high schools in Awassa City, Ethiopia. The evaluation assessed how ARH education was provided, extracurricular activities, and the linkage between education and ARH services. Key findings include: 1) Most adolescents reported receiving ARH education in school, though sessions were irregular; 2) Extracurricular activities reached some but not all adolescents; 3) Most adolescents were aware of ARH services and providers like health facilities. The evaluation concluded the education provision and linking adolescents to services was generally successful, but extracurricular activities and outreach needed strengthening.

1. By:
Fikru Tessema
Advisors:
Dr Mirkuze Wolde (MD, MPH)
Mr Yohannes Dibaba ( BSc, MA)
Dr Frehiwot Brehane (MD, MPH)
20 May 2008
1

2. 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

3.  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

4.  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

5.  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

6.  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

7.  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

8.  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

9. 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?
9

10. (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.
10

11. (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.
11

12. 12
Program products:
In-school
adolescents
reached with RH
education, training
of educators and
health information
on RH services
Formatting the program
Compliance
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,
Continuity
Program
inputs:
Program
funds, HR,
strategy,
standards,
IEC/BCC
materials,
HFs
Availability
Adolescent RH related issues
Retain
interventions
or
take
corrective
measures
Sustain process of the program

13. 13
Study area and
period
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
and technique
A case study method with both qualitative in-
depth interview and quantitative survey
Source
population
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

14. 14
Sampling
technique
Two high schools have been selected purposively
for surveying of students, and
Surveying of all Biology teachers teaching in
grade 9 and 10
Sample 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. 15
Aawasa & Addis
Ketema High
Schools
Awasa 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)

16.  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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17. 17
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, cross tab,
graphs
Schools
(teachers,
students)
Pre-test, Training,
Supervision, Double
data entry and
Meta Evaluation:
⁃ utility,
⁃ feasibility,
⁃ accuracy and
⁃ propriety standards

18.  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
18

19. 1. Socio-Demographic Characteristics of the respondents
 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.
19

20.  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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21. 2. 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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22. 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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23. 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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24. 3. Extracurricular activities related to ARH education in 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
24

25.  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
25

26.  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
26

27. 4. 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. 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 in
school
Teachers in school Peers in school Parents Mass media Health workers Others (OSY,
NGOs, etc)
Soursces
NoofRespondents
(45.5%)(43.6%)
(27.2%)
(25.6%)

29.  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, “… እእ
እእእእእእእእእ እእእእእ እእእእ እእእእ እእእ እእ እእእ
እእእ እእእእእእእ…”
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30.  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

31.  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

32.  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.
32

33.  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

34.  This evaluation:
◦ was done in two high schools of Awassa town, which
may not represent other high schools in the country.
34

35.  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

36.  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

37.  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

38. 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.
38

39.  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
39

40. 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