Rationale and design of the MEMA kwa Vijana adolescent sexual and reproductive health intervention in Mwanza Region, Tanzania

Abstract

Large-scale innovative, integrated, multifaceted adolescent sexual and reproductive health (ASRH) interventions are urgently needed in sub-Saharan Africa. Implementation through schools and health facilities may maximize intervention coverage and sustainability, however the impact of the use of these structures on intervention content and delivery is not well documented. This paper describes the rationale and design of a large-scale multifaceted ASRH intervention, which was developed and evaluated over three years in rural communities in Mwanza Region, North West Tanzania. The intervention comprised community mobilization, participatory reproductive health education in primary schools, youth-friendly reproductive health services and community-based condom provision for youth. We examine the effect of socioeconomic, cultural and infrastructural factors on intervention content and implementation. This paper demonstrates the means by which such interventions can be feasibly and sustainably implemented to a high standard through existing government health and school structures. However, the use of these structures involves compromise on some key aspects of intervention design and requires the development of complementary strategies to access out-of-school youth and the wider community.

Acknowledgments

The work reported here was funded by the European Commission, with additional funding from UNAIDS and from the Health and Population Division of the UK Department for International Development.

Dr Obasi and Ms. Plummer were funded by the Medical Research Council of the United Kingdom. This intervention was developed as part of a collaborative study between the Tanzanian National Institute for Medical Research (NIMR), AMREF, the London School of Hygiene and Tropical Medicine (LSHTM), and the Ministries of Health and of Education and Culture of the Government of the United Republic of Tanzania. We thank the MoH, the MoEC, the NACP, the Tanzanian Medical Research Co-ordination Committee, and the LSHTM Ethics Committee for permission to carry out and publish the design of this intervention. We are also grateful to the Regional Medical and Education Officers of Mwanza, the Director of NIMR, Mwanza, the AMREF country director and other staff in the AMREF country office for their support. Special thanks are due to the pupils, community youth, teachers, ward education co-ordinators, health workers and other officials who assisted in the development and implementation of this programme including colleagues in AMREF Mwanza (Merdad Rwakatare, Hawa Shambe, Emmanuel Mrita, Prisca Methusela, Gaudensia Byontamanyire, John Enos, Salma Jabir, Rachel Alex & Joseph Charles), and NIMR Mwanza (John Changalucha, Frank Mosha, Gerry Mshana, Joyce Wayomi, Zachayo Salamba).

This paper is dedicated to the memory of Mr Bartimayo Mujaya, Regional Education Officer, Mwanza.

Notes

1. The intervention co-ordinator was commissioned by WHO to conduct a situation analysis as part of the piloting of ‘WHO/UNICEF/UNFPA Framework for country programming for Adolescent Health’.

2. Ministries of Education & Culture, Health, Community Development and Women and Children's affairs and the Ministry of Labour and Youth.