Five key domains for complementary actions
The need for complementary actions to support positive sexual health outcomes for young people are well documented, and should take place across the following five key domains:
- Laws, policies, and human rights
Affirmative legal or policy interventions are critical for supporting existing sexual health interventions or introducing new ones. Countries may use laws, policies, and other regulatory mechanisms that are enshrined in international treaties to guarantee the promotion, protection, and provision of sexual health information and services, and to uphold the human rights of every person within their borders.
The correlation between education level and sexual health outcomes has been well documented. One of the most effective ways to improve sexual health in the long term is a commitment to ensuring young people are sufficiently educated to make healthy decisions about their sexual lives. Accurate, evidence-based, appropriate sexual health information and counselling should be available to all young people, and should be free of discrimination, gender bias, and stigma. This reality provides among the strongest rationales for integrating CSE in schools.
- Society and culture
Social and cultural factors can be significant in determining people’s access to sexual and reproductive health services and information. The influence of traditional values, beliefs, and norms must not be underestimated. They affect the family, the community, and society, and play an important part in shaping people’s sexual lives. While the sociocultural determinants of sexual health outcomes vary in time and place, it seems the groups in society that have relatively little power have poorer sexual health, often because they lack access to information and services or legal redress. Gender-influenced power relations, for example, have a significant effect on the sexual health of many women and girls. CSE programmes should be linked with community-based organizations or networks of people with diverse sexual orientation and gender identity or expression (SOGIE) or of people living with HIV (PLHIV), etc. so that learners can get direct information from them and educators are not burdened with having to conduct conversations about ‘difficult’ issues all by themselves.
Poverty and economic inequality are intrinsically linked to poor sexual and reproductive health outcomes. These links are multi-directional, inasmuch as people living in poverty experience worse sexual and reproductive health than those in better economic situations, and poor health leads to poverty. Financial necessity is often a driving force behind some forms of high-risk sexual behaviours. Health interventions can therefore only be effective if the relationships between a person’s economic needs, vulnerability, and health outcomes are fully understood and addressed, in both the short and long term. Creating links with self-help groups or income-generating activities might enhance the effectiveness of a CSE programme when it is reaching young people who live in poverty.
- Health systems
Accessible, acceptable, affordable, and good-quality sexual health services are fundamental to achieving a sexually healthy society. Interventions to maintain and ensure sexual health have been shown to work best when they are offered to people of all ages, throughout their lifetime, regardless of marital status. It is also important to make efforts to target young people in particular because of their social and biological vulnerability. Providers should be trained to screen and detect sexual health problems and provide appropriate educational information about prevention, counselling, treatment, care, and referral.
[Excerpted and adapted from: WHO. 2010. Developing sexual health programmes: a framework for action.]
CSE that includes community-based components – including involving young people, parents, and teachers in the design of interventions – results in the most significant change. Research has made apparent the need to link the provision of CSE and other complementary interventions to SRH services. This includes the need to:
- build awareness, acceptance, and support for youth-friendly CSE and SRH services among clients and their gatekeepers;
- address gender inequality in terms of beliefs, attitudes, and norms;
- target younger learners, in particular those in the early adolescent period (10–14 years);
- ensure health care providers are trained and supported in youth-friendly delivery of services, including being non-judgemental and friendly;
- ensure that health facilities are welcoming and appealing to young people.
[Source: UNESCO. 2017. CSE scale-up in practice: Case studies from Eastern and Southern Africa.]
At the local level, coordinating CSE with complementary programmes can involve two main efforts. The first is to scan a community or area to determine what is currently being offered to avoid duplicating efforts. The second is to determine whether and how partnerships may be available in order to maximize the impact of CSE, whether as a stand-alone or a programme integrated into other programmes and services.
Three types of partnerships
- Leverage/Exchange: those in which each partner brings discrete skill sets or resources to complement the other. For example, a community may be prepared to provide in-person teacher training on CSE, but is not up to date on trauma-informed approaches. It would help to partner with a local organization with expertise in that area to provide a co-facilitator or guest speaker to participate in the training.
- Combine/Integrate: those in which the entities are engaged from and invested in the programme from the beginning. These partnerships require much more planning up front, as they also involve discussing and sharing resources. For this reason, these partnerships are most effective when a sufficient amount of time is built into the process to build trust and collaboration, or when the partner is a known entity with which a school/community organization may have had previous experience.
- Transform: those involving numerous partners and an approach that is not necessarily set and agreed upon in advance. The direction may emerge, change, or evolve as the process moves forward. As such, partners need to check in and negotiate parameters of the partnership and initiative goals on a regular basis.
[Source: The Partnering Initiative; UNDESA. 2019. Maximising the impact of partnerships for the SDGs: A practical guide to partnership value creation.]
Tips for establishing community partnerships
The UNICEF strategic framework for partnerships and collaborative relationships points to five criteria that underlie successful work with partners:
The strategic framework further highlights the need for explicit agreements, regular review, monitoring and evaluation, conformity to existing rules and procedures that reinforce equality and transparency, and an exit process that can lead to discontinuation of a partnership if necessary.
[Source: United Nations. 2009. UNICEF strategic framework for partnerships and collaborative relationships.]