Partnering to proceed: scaling up adolescent sexual reproductive health programmes in Tanzania. Operational research into the factors that influenced local government uptake and implementation

Abstract

BackgroundLittle is known about how to implement promising small-scale projects to reduce reproductive ill health and HIV vulnerability in young people on a large scale. This evaluation documents and explains how a partnership between a non-governmental organization (NGO) and local government authorities (LGAs) influenced the LGA-led scale-up of an innovative NGO programme in the wider context of a new national multisectoral AIDS strategy.MethodsFour rounds of semi-structured interviews with 82 key informants, 8 group discussions with 49 district trainers and supervisors (DTS), 8 participatory workshops involving 52 DTS, and participant observations of 80% of LGA-led and 100% of NGO-led meetings were conducted, to ascertain views on project components, flow of communication and decision-making and amount of time DTS utilized undertaking project activities.ResultsDespite a successful ten-fold scale-up of intervention activities in three years, full integration into LGA systems did not materialize. LGAs contributed significant human resources but limited finances; the NGO retained control over finances and decision-making and LGAs largely continued to view activities as NGO driven. Embedding of technical assistants (TAs) in the LGAs contributed to capacity building among district implementers, but may paradoxically have hindered project integration, because TAs were unable to effectively transition from an implementing to a facilitating role. Operation of NGO administration and financial mechanisms also hindered integration into district systems.ConclusionsSustainable intervention scale-up requires operational, financial and psychological integration into local government mechanisms. This must include substantial time for district systems to try out implementation with only minimal NGO support and modest output targets. It must therefore go beyond the typical three- to four-year project cycles. Scale-up of NGO pilot projects of this nature also need NGOs to be flexible enough to adapt to local government planning cycles and ongoing evaluation is needed to ensure strategies employed to do so really do achieve full intervention integration.

Standardizing and scaling up quality adolescent friendly health services in Tanzania

“…Current modern contraceptive use among women ages 15–19 increased from 5.8% in 1999 to 9.4% in 2010 [28,29]. HIV prevalence declined from 2.1% in 2003/04 to 1.0% in 2007/08 among those aged 15–19 [30,31]. While government efforts related to scaling up AFHS were by no means solely responsible for these improvements in adolescent sexual and reproductive health outcomes, it is certainly possible that the efforts to improve access to and quality of health services for adolescents along with complementary efforts to inform, educate, empower and support adolescents has contributed to improving their health status.…”

“…The quality standards not only serve as benchmarks for assessing, guiding, and providing quality adolescent friendly health services, but they are also useful in that they can be institutionalized into work plans and budgets. The Youth Friendly Services training manual [22] developed by the MOHSW as well as the Adolescent Health and Development Strategy [1] supported the scale up of MkV [12] and stimulated financial contribution by some council governments [31]. One concrete example is that following the end of the AYA project several local governments provided funds for the expansion of activities to additional facilities to improve the adolescent friendliness of health facilities [15].…”

“…Evaluations of the scale up of the health services component of the MkV project to cover the Mwanza region found that contextual factors, such as high turn over rates of local government officials, staff shortages, and inadequately equipped facilities inhibited the scale up of services [12,31]. Similar barriers to scaling up may in part explain why some districts perform better than others.…”

A ‘Mystery Client’ Evaluation of Adolescent Sexual and Reproductive Health services in Health Facilities from Two Regions in Tanzania

“…The Government of the United Republic of Tanzania was one of the first African countries to respond to the WHO call for action for improved reproductive health service provision for young people, setting standards for youth friendly reproductive health services over a decade ago [ 11 , 12 ]. As part of the Mema kwa Vijana phase 2 (MkV2) programme, YFRHS training was rolled out in all government health facilities in 4 districts (Sengerema, Geita, Kwimba and Missungwi) in Mwanza Region, Northern Tanzania between 2004 and 2007.…”

CAHRD Consultation 2014: the 10-20 year Horizon Introduction and Overview – as circulated to Consultation participants

“…In addition to evaluation of the process of implementation, this research uniquely examined the local government policy process related to scale up and informed the 2013 UNESCO consultation on sexuality education. [ 26 - 28 ]…”