Comprehensive Sexuality Education: The Challenges and Opportunities of Scaling Up

"Even in countries with the highest HIV rates, there are relatively few examples of scaled-up, sustainable programmes within educational curricula."

This study builds upon the work of the United Nations Educational, Scientific and Cultural Organization (UNESCO)’s Section of HIV and Health Education response to the need to develop adequate levels of HIV prevention knowledge among children and young people through schools and other education programmes beyond pilot projects to find models for scaled up, nationally adopted, affordable, and sustainable programmes. "The report emphasizes the challenges for scaling-up in terms of integrating comprehensive sexuality education into the formal curricula of schools. It aims to:

• Provide conceptual and practical guidance on definitions and strategies of scaling-up, given the specificities of sexuality education.
• Illustrate good practice and pathways for successful scale-up in light of diverse contextual parameters.
• Provide some principles of scaling up sexuality education that are of relevance internationally."

Research for the report included a literature review and semi-structured interviews within UN agencies, non-governmental organisations, and research institutions and includes six case studies in Finland, Kenya, Nigeria, Tanzania, Thailand, and Uruguay.

Ten key principles for scaling up sexuality education have been identified:

1. "Choose an intervention/approach that can be scaled up within existing systems.
2.  Clarify the aims of scaling-up and the roles of different players and ensure local/national ownership/lead role.
3. Understand perceived need and fit within existing governmental systems and policies.
4. Obtain and disseminate data on the effectiveness of pilot programmes before scaling up.
5. Document and evaluate the impact of changes made to interventions on programme effectiveness.
6. Recognize the role of leadership.
7. Plan for sustainability and ensure the availability of resources for scaling up or plan for fundraising.
8. Plan for the long term (not donor funding cycles) and anticipate changes and setbacks.
9. Anticipate the need for changes in the ‘resource team’ leading the scaling-up process over time.
10. Adapt the scaling-up strategy with changes in the political environment; take advantage of ‘policy windows’ when they occur.

The author concludes that institutionalising sexuality education within schools is not only cost effective but it is a right of current and future cohorts of young people. However, scaling-up requires a plan and a methodology, including a budget and a division of roles and responsibilities. Moreover, scaling-up needs to incorporate strategies for garnering and sustaining political commitment over time, as well as for building implementation capacity.

The consultation concludes that a lack of planning (including budgeting) for coordination across players - 'bringing the diverse pieces of the puzzle' together – has been the main obstacle to scaling-up. Governments with a pro-active scaling-up strategy that are committed to institutionalizing sexuality education and ensuring it is delivered appropriately at scale should be in the driving seat, rather than being subject to the diverse agendas of different interest groups (including funders). This would ensure that all players conform to national priorities developed through partnership with key stakeholders, including young people themselves."