The East and Southern Africa Ministerial Commitment: a review of progress toward fulfilling young people's sexual and reproductive health and rights (2013–2018)

Figures & data

Figure 1. New HIV infections and comprehensive knowledge of HIV among young people 15 to 24 years old

. Data source: AIDSInfo 2013–2018 data. http://aidsinfo.unaids.org/; 2010–2018 DHS, MICS, AIS reports

Figure 2. Condom use and HIV testing behaviour among young people aged

Box 1: Methods used to collect data for each research question

Research question	Data collection methods
What was the context within which the ESA Commitment was developed?	Document review Key informant interviews
What was the process for affirming/endorsing the ESA Commitment?	Document review
How has progress been measured during the first five years of implementation?	Document review
What progress has been made in the first five years of implementation?	Document review Key informant interviews
What has helped and hindered the implementation?	Document review Key informant interviews

Table 1. Who’s who

Joint United Nations Programme on HIV and AIDS (UNAIDS)	This was the UN agency tasked with coordinating the ESA Commitment Initiative.
United Nations Educational, Scientific and Cultural Organization (UNESCO), United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), World Health Organization (WHO)	These were the other UN agencies involved in the affirmation/endorsement and implementation of the ESA Commitment and that provided technical and financial support.
Southern African Development Community (SADC), Eastern African Community (EAC), COMESA (Common Market for Eastern & Southern Africa)	Regional economic communities (RECs) supported and liaised with governments throughout the ESA Commitment affirmation/endorsement and implementation stages and have been important partners in the accountability processes.
Federal Ministry for Economic Cooperation and Development (BMZ), Ford Foundation, Swedish International Development Cooperation Agency (SIDA), Swiss Agency for Development and Cooperation (SDC)	These are the bi-lateral donor agencies that have provided technical and financial support for the ESA Commitment affirmation/endorsement and implementation.
High Level Group (HLG)	Created for the ESA Commitment Initiative, the HLG is comprised of key regional leaders in SRH and education, young people and civil society with support from the RECs and the UN; it was led by Dr Sheila Tlou of UNAIDS and convened by UNESCO (on behalf of partners). The HLG steered the ESA Commitment process and played a key role in advising on the formulation of the final written commitment.
Technical Coordinating Group (TCG)	The TCG is a group of UN partners (UNFPA, UNICEF, WHO, UNAIDS and UNESCO), development partners (BMZ, SIDA, SDC, and USAID), civil society organisations (INERELA+, IPPF, Rebranding HIV) and Regional Economic Communities (SADC and EAC), the function of which is to provide technical support to the HLG and to assist in mobilising support and resources at regional and country level. There is also an expanded TCG, which included country representatives.
Civil Society Platform	CSOs were engaged from the outset. Their involvement was strengthened by the development of a CSO engagement strategy, which was based on the recognition of the need to systematically engage them in the realisation of the ESA Commitment in the region, and ensuring accountability as well as space and voice of youth at all levels. A regional coordination task team was established consisting of the following organisations: AIDS Accountability International, EANNASO, AFRIYAN, DHAT, SAT and SAFAIDS.

Table 2. Timeline

Date	Event
Oct–Dec 2011	UNESCO, UNAIDS and BMZ launched the ESA Commitment Initiative High Level Group (HLG) and Technical Coordinating Group (TCG) established
Jan–Dec 2012	Health and Development Africa developed a diagnostic report commissioned by UNESCO that included evidence on HIV and sexuality education; accessibility of SRH services; rates of HIV and other sexually transmitted infections (STIs) amongst young people; and rights-based concerns related to gender inequalities, sexual identities and stigma and discrimination.
Jan–Mar 2013	UNESCO and Ford Foundation hosted a Southern Africa civil society consultation to review the diagnostic report HLG and TCG met face-to-face for the first time to review and endorse the diagnostic report
Apr–Jun 2013	UNESCO and IPPF hosted an Eastern Africa civil society consultation to review the diagnostic report HLG drafted recommendations for the ministerial commitment UNESCO with UNFPA drafted the text that ultimately formed the basis of the ministerial negotiations Country consultations took place in all twenty-one countries to validate the diagnostic report findings
Jul–Sep 2013	Country consultations continued in all twenty-one countries to validate the diagnostic report findings HLG advocacy with key policy makers in the region to garner support for the Commitment Diagnostic report launched at regional and national levels in October
Oct–Dec 2013	Twenty countries met and affirmed/endorsed the Commitment, which went into force on 7 December 2013.
Jan–Mar 2014	UN partners met and developed indicators for the regional accountability framework (RAF) based on data already collected in the region TCG tasked with monitoring implementation and developing progress reports for SADC and EAC Civil society monitoring platform created

Table 3. ESA Commitment targets

2015 Targets

2020 Targets

4.1 A good quality CSE curriculum framework is in place and being implemented in each of the 20 countries; 4.2 Pre and in-service SRH and CSE training for teachers, health and social workers are in place and being implemented in all 20 countries; 4.3 By the end of 2015, decrease by 50% the number of adolescents and young people who do not have access to youth-friendly SRH services including HIV that are equitable, accessible, acceptable, appropriate and effective.

4.4 Consolidate recent and hard-won gains in the reduction of HIV prevalence in ESA, and push towards eliminating all new HIV infections amongst adolescents and young people aged 10–24; 4.5 Increase to 95% the number of adolescents and young people, aged 10–24, who demonstrate comprehensive HIV prevention knowledge levels; 4.6 Reduce early and unintended pregnancies among young people by 75%; 4.7 Eliminate gender-based violence; 4.8 Eliminate child marriage; 4.9 Increase the number of all schools and teacher training institutions that provide CSE to 75%

Table 4. ESA Commitment progress

Indicators	Baseline	2015 Progress	2018 Progress	2020 Target	Explanatory comments
Target : A good quality CSE curriculum framework is in place and being implemented in each of the 21 countries^a
% of schools that provided life skills-based HIV and sexuality education in the previous academic year^18^,^19^,^20	Not available	88% (Primary) 71% (Secondary)	14 out of 15 countries that reported on this indicator showed varying levels of coverage from 5% to 100%	95%	The 2015 and 2020 figures were extracted from the RAF, which states that the 2015 figure is based upon 2015 ESA Commitment country reports. The 2018 figure was taken from the 2018 report and was also based on country reports.
Number of countries that have a costed national CSE strategy or framework for out-of-school youth^18^,^19^,^20	2 countries	Not available	17 countries	20 countries	The baseline, 2018 and 2020 figures were extracted from the 2018 progress report. The 2015 progress report presents three different figures for 2015. On page 33, it states that 16 countries have a costed strategy, whilst page 35 states that it is 15 in Figure 3.2. In the country annex, only 6 countries report having such a strategy. In addition, the RAF shows that 14 countries had a national CSE strategy or framework for out-of-school youth by the end of 2014. No data is presented in the table given these discrepancies. In the RAF, the indicator wording omits “costed“ and appears as “Number of countries with a national CSE strategy or framework for out of school youth.” However, the word “costed” appears in the 2015 and 2018 reports.
% of schools with teachers who received training, and taught lessons, in life skills based HIV and sexuality education in the previous academic year^18^,^20	Not available	76% (primary) 56% (secondary)	Not available	90%	This indicator appears in the RAF and the 2015 report but not in the 2018 progress report. The data presented for 2015 is found in the RAF and is based upon the 2015 ESA country reports.
Target: Pre- and in-service CSE and SRH training for teachers and health and social workers is established and being implemented in all 20 countries
Number of countries that provide pre-service and/or in-service training programmes on the delivery of CSE^18^,^19	2 countries	Pre-service: 10 countries In-service: 20 countries	20 countries	20 countries	The baseline and 2018 figures were extracted from the 2018 report. The 2015 figures are from the 2015 report. The 2020 target is from the wording of the ESA Commitment target.
Number of countries that provided pre- and in-service training programmes on the delivery of AYFHS^18^,^19^,^20	No baseline available	Pre-service: 10 countries In-service: 17 countries	21 countries	20 countries	The 2018 figure was in the 2018 report; the 2015 figures were in the 2015 report; and the 2020 target was in the RAF.
Target: Decrease by 50% the number of adolescents and young people who do not have access to youth friendly SRH services, including HIV-related services that are equitable, accessible, acceptable, appropriate and effective
Number of countries with a costed national strategy/plan to improve young people’s access to youth-friendly health services aligned to regional/ international standards^18^,^20	Not available	20 countries	Not available	20 countries	The 2015 figure was taken from the 2015 report, and the 2020 target was found in the RAF.
Percentage of health service delivery points that offer a standard / minimum package of adolescent/ youth friendly/sensitive health services^18^,^19^,^20	Not available	65% of countries offer a standard minimum package of YFSRH services	Eswatini (74%) Kenya (23%) South Africa (100%) Tanzania (30%) Uganda (17%) Zimbabwe (20%)	Not available	The 2015 figure comes from the 2015 report, which includes a different wording of the indicator: “% of countries that offer a standard minimum package of youth friendly SRH services.” In the 2018 report, the wording switched back to that which appears in the RAF. In the 2018 report, figures were presented only for the few countries that were able to report on the indicator that year.
Percentage of adolescent girls and boys and young women and men aged 10–24 and living with HIV currently receiving antiretroviral therapy^20	Not available	Not available	Not available	Increase by 75% of baseline	This indicator appears only in the RAF. The RAF erroneously refers to a “reduction by 75%” for the 2020 figure, rather than an “increase.” The wording has been changed in this table.
Target: Eliminate all new HIV infections among adolescents and young people aged 10-24
Number of new HIV infections among adolescents and young people (15–24 years)^18^,^19^,^20	430,000 (2013)	236,196 F 115,216 M (excludes Burundi, DRC, Ethiopia and Seychelles and includes Eretria)	293,570 (2017)	Reduction by 75% of baseline (n = 107,500)	The baseline, 2015 and 2020 figures were found in the RAF. The 2018 figure was found in the 2018 report. The RAF and 2015 report indicate that the source for the baseline figure was UNAIDS’ estimates from 2013. The RAF indicates that the 2015 figure is based on 2016 UNAIDS estimates. The 2018 figure is presented in the 2018 report as being derived from the 2017 UNAIDS estimate.
Percentage of never married women and men aged 15–24 years who had sexual intercourse in the past 12 months and used a condom at the last sexual encounter^19^,^20	Not available	Not available	Amongst reporting countries, most reported an increase in condom use at last sex, except for Ethiopia, which reported a decrease; percentage increases varied from 39.2% to 72.5%	75% decrease from baseline	The 2020 figure was presented in the RAF. The 2018 data were found in the 2018 report and are presented as they appear therein.
Percentage of sexually active women and men aged 15–24 who have been tested for HIV and received results in last 12 months^18^,^20	Not available	23% (M) 30% (F)	Not available	Increase by 75% of baseline	The 2015 and 2020 figures were found in the RAF. The source cited in the RAF for the 2015 figure is the State of the World’s Children Report( 2016). The 2015 progress report presents different data for 2015 – 36.4% for men and 58% for women (aged 15–24); the citation for this is the Global AIDS Response Progress Reporting 2015. The wording in the RAF for the 2020 target read “reduction by 75% of baseline.” It is assumed that this was a mistake, thus it has been changed in this table to read “increase.”
Target: Increase to 95% the number of adolescents and young people aged 10-24 who demonstrate comprehensive HIV prevention knowledge levels
Percentage of AYP aged 15–24 years who have comprehensive HIV prevention knowledge^18^,^19^,^20	41% M 35% F	45% M 42% F	40% (composite)	95% (composite)	The baseline figure is extracted from the RAF, which cites the 2014 State of the World’s Children report as the source. The 2015 figure is found in the 2015 report, with a citation explaining that it is based on DHS data for just 12 countries. The 2018 report mentions a composite figure of 36% for 2015. The 2018 value comes from the 2018 report; on page 17, the report states that 40% is a 2017 figure from UNAIDS that represents an increase from the 2015 UNAIDS figure of 36%. There is a discrepancy between the figures used in the 2015 and 2018 reports for this indicator. The 2020 target is taken from the ESA Commitment target wording. Although the ESA Commitment target mentions the 10 to 24 age bracket, all of the data used to report on this indicator are for the 15 to 24 age bracket.  Different wording is used for this indicator in the RAF, which reads: ‘Percentage of young people aged 15–24 who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission.’
Target: Reduce early and unintended pregnancies among young people by 75%
Number of countries implementing a national policy/ strategy on pregnant learners^19^,^20	5 countries	10 countries	16 countries	20 countries	The baseline and 2018 figures are taken from the 2018 report. The 2015 and 2020 figures are taken from the RAF. There is a discrepancy in the reporting of the 2015 figure, which appears as ‘9’ in the 2018 report. The 2018 report uses a different wording of the indicator, adding the words “and readmission” to the end.
Percentage of women age 15–19 who have begun childbearing^18^,^20	Births by age 18: 27%	Not available	Not available	Reduction by 75%	The baseline and 2020 figures were extracted from the RAF. The State of the World’s Children report (2014) is stated as the source for the baseline figure. A proxy indicator – births by age 18 – is used for the baseline. Data on this indicator in the 2015 report is presented separately for each of the 12 countries for which data are available; no aggregated figure is given.
Target: Eliminate gender based violence
Number of countries whose education sector policies address school-related GBV^19^,^20	7 countries	12 countries	18 countries	20 countries	All figures come from the 2018 report.
Percentage of women aged 15–24 who believe that wife-beating is justified for at least one of five specified reasons^19^,^20	54%	52%	6.4% South Africa 13.3% Mozambique 18.6% Malawi 24.9% Angola 48.6% Zimbabwe 53.4% Uganda 59.4% Tanzania 60.3% Ethiopia	Reduction by 75% to 13.5%	The baseline and 2015 figures come from the RAF, which uses the following proxy indicator from the State of the World’s Children Report (2014 and 2016, respectively): ‘percentage of girls and boys 15–19 years old who consider a husband to be justified in hitting or beating his wife for at least one of the specified reasons, i.e., if his wife burns the food, argues with him, goes out without telling him, neglects the children or refuses sexual relations.’ The 2018 data is from the 2018 report, which presents data from the 8 countries in the region with population-level surveys administered after 2015. These data are for young women aged 15–24.
Percentage of education institutions that have rules and guideline for staff and students relating to physical safety, stigma and discrimination and sexual harassment and abuse that have been communicated to relevant stakeholders^20	Not available	Not available	Not available	50%	This indicator is only included in the RAF and not in any progress reports.
Target: Eliminate child marriage
Number of countries with programmes to prevent and mitigate against child marriage where prevalent^18^,^19^–^20	Not available	12 countries	18 countries	20 countries	There are no baseline data available for this indicator. The figure in the 2015 column is from the RAF and the source is cited as the 2014 ESA Commitment country progress reports. The 2020 figure is also from the RAF. The 2018 figure is from the 2018 progress report.
Percentage of women aged 20–24 years who were first married or in union before age 15 and age 18^19^,^20	10% by 15 years 38% by 18 years	10% by 15 years 36% by 18 years	Varies by country; significant progress in ESA but large disparities in child marriages between income quintiles, rural-urban divides, or by education levels	Reduction of 75% from baseline to .9% married by 15 and 3.6% married by 18	The baseline and 2015 figures are found in the RAF; the sources cited are the State of the World’s Children Report 2014 and 2016, respectively. The 2020 figures are also taken from the RAF. The 2018 report presents findings by country for 18 countries utilizing the latest DHS (or similar) survey data from each. Some of these surveys pre-date the ESA Commitment.
Target: Increase the number of all schools and teacher training institutions that provide CSE to 75%
Not available	Not available	Not available	Not available	Not available	This target is found in the original, affirmed ESA Commitment but not in any other reports or documents. There were no indicators set for this target in the RAF.
Target: Creating an enabling environment (not an original target within the ESA Commitment)
Number of countries implementing a multisectoral strategy or framework for operationalization of the ESA Commitment^19^,^20	0 countries	18 countries	19 countries	20 countries	The baseline and 2020 figures are found in the RAF. The 2015 and 2018 figures are taken from the 2018 report.
Number of countries with a multisectoral task team established and functional to provide policy and technical guidance^19^,^20	0 countries	14 countries	12 countries	20 countries	The baseline and 2020 figures are found in the RAF. The 2015 figure is also from the RAF but is from 2014. The 2018 figure is found in the 2018 progress report.
Number of countries having earmarked /mobilised financial resources for the implementation of the ESA Commitment^19^,^20	0 countries	12 countries	12 countries	20 countries	The baseline, 2015 and 2020 figures are taken from the RAF. The 2015 figure, however, is from 2014. The 2018 figure is taken from the 2018 report.

^a Rwanda was the twenty-first country to affirm the ESA Commitment, although representatives from the country were not in attendance at the gathering during which it was affirmed.

Table

ESA Commitment target	Indicator (DHS/MICS)	Kenya		Uganda		Zambia		Malawi
		2008/2009	2014	2011	2016	2013/2014	2018	2010	2015/2016
Reduce early and unintended pregnancies among young people by 75%	% of adolescent girls who have begun childbearing	17.7	19.2 (2015 MIS)	23.8	19.6 (MIS)	28.5	29.2	25.6	31.5 (2017 MIS)
Eliminate gender-based violence	% of adolescents (aged 15–19) who think a husband is justified in hitting or beating his wife in certain circumstances [female]	56.6	44.5	61.8	57.5	48.6	46.5	16.4	20.7
	% of adolescents (aged 15–19) who think a husband is justified in hitting or beating his wife in certain circumstances [male]	54.1	36.7	52.2	53.0	40.6	31.5	20.7	23.7
Eliminate child marriage	% married/in union before age 18 (aged 20–24) [female]	26.4	22.9	39.7	34.0	31.4	29.0	49.6	42.1
	% married/in union before age 15 (aged 20–24) [female]	6.2	4.4	9.9	7.3	5.9	5.2	11.7	9.0
Increase to 95% the number of adolescents and young people aged 10–24 who demonstrate comprehensive HIV prevention knowledge levels	% of adolescents with comprehensive knowledge about AIDS [female]	51.2	57.7	35.6	34.8	38.9	40.5	39.5	38.9
	% of adolescents with comprehensive knowledge about AIDS [male]	42.0	49.0	40.7	40.2	42.3	38.6	44.7	43.1

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