Background
There is a high-unmet need for contraception among adolescents in Kenya. This is linked to an early age of first delivery and the high rates of school dropout incidents by young mothers.
Lacking knowledge of or access to contraceptives hinders girls’ ability to make decisions about their lives and future, leading many adolescent women to become young mothers and abandon their education, driving high dropout rates in secondary schools, robbing women of the chance to have an education.
The reasons for low contraceptive uptake among adolescents are complex, and many girls lack agency and control over their lives, lack access to reliable sources of contraception information and financial resources, and have limited ability to travel to seek services. Socio-cultural and gender norms that promote early marriage and childbearing can put them at risk, and norms that stigmatize pre-marital sex prevent unmarried girls from seeking contraception services.
In addition, service delivery is often not youth-friendly and fear of judgement and stigmatization by the providers or the wider community puts adolescents off obtaining services at public clinics.
The Calculus of Sex CSE School Programme
The Calculus of Sex School programme is the Comprehensive Sexuality Education (CSE) that MSK will implement in schools within the three counties of Mombasa, Bungoma & Trans Nzoia for BMGF. The CSE programme commenced in June 14 and will last four years. The CSE is to build on the successes and lessons learned from MSK’s existing youth programs, especially from the ITH Project school programme’s one-year pilot intervention conducted in the two counties of Mombasa and Nakuru.
The CSE will in essence continue to be part of the Government’s policy in ASRH and will be working with the MOH and MOE at county level. It will augment what already exists, build capacity and add value to the content. This is because it will use the Tuko Pamoja curriculum developed for the school health program by Path and Population Council, for use in the public primary and secondary schools.
A research conducted by APHRC in 2017 reflected that nationally, more than a third of 15-19 year-old adolescents have had sex. Only 4 in 10 unmarried, sexually active adolescents currently use a contraceptive method and more than half of them have an unmet need for family planning. Regarding sexuality education in schools, the study conducted amongst students in Nairobi, Homa Bay and Mombasa indicated that at least 60% of the students are interested in getting more information that will enable them effectively protect themselves from unintended pregnancies, but they are not receiving such information in school.
Among teachers who cover the topics in schools, 70% according to the research have received pre-service training that included any topics related to sexuality education. However, slightly more than a third of them benefited from in-service training, which is essential for keeping teachers adequately prepared to teach accurately, appropriately and effectively. Only 13% of teachers received such training in the past year. Teachers also cited a lack of resources and time as being a barrier to their teaching of sexuality education in schools. The study established that when faced with over-packed schedules and the need to reduce certain subjects, schools often choose to prioritize other more “examinable/important” subjects over SE, further reinforcing the problem.
The research indicated that the government is committed to providing sexuality education in schools, as early as the primary level – as demonstrated in the 2013 declaration. Principals, teachers and key informants agree that school-based sexuality education is important. However, teachers need more support in their teaching of SE, the coverage of topics lacks comprehensiveness, and many key issues are missing.
Under Calculus of Sex, MSK will refine a model for integrated CSE and SRH service delivery for in-school adolescents (15-19 years old) and out-of-school young people (20-24) which will increase contraceptive use among sexually active adolescents and have the potential for scale up nationally.
The CSE content will include health talk sessions on; Values and Interpersonal Skills, Sexual and Reproductive Physiology, Sexuality and Behaviour, Prevention of Unwanted Pregnancy (contraception) and HIV/STI Prevention among others.
This CSE will be delivered by a SHN, in conjunction with MOH PHOs / RHCs. The health talk content is adapted from a curriculum developed earlier by PATH for the Life skills course and approved by the MOH & MOE. Under Calculus of Sex CSE the curriculum will address harmful gender norms and empower adolescents to make informed decisions.
Expected Primary Outcome
Adolescents are informed about their sexual health options, empowered to make decisions and seek access to contraceptive services at youth friendly access points.
Theory of Change
Calculus of Sex – CSE Programme Vision
MSK is unwavering in our commitment to ensuring women have choice when it comes to their reproductive health. As a vulnerable population, we are particularly committed to protecting this right among adolescents by creating an environment that encourages both learning and access around contraception. For this investment, that means addressing several barriers in the way of accessing contraception as an adolescent girl in Kenya. We will;
Increase knowledge and improve healthy attitudes relating to sexual and reproductive health and rights (SRHR) for adolescents both in and out of schools
Improve and increase adolescents’ access to service delivery points by bringing school health nurses to girls, service providers to community events, and youth-friendly practices to existing clinics and pharmacies
Ensure sustainability of this approach by gaining the government support and buy-in that will allow the project to continue when we are gone.
All of this will be underpinned by a strong research component, which will pave the way for future roll-out to additional areas by generating an evidence-base to advocate for the model’s effectiveness.
The Current content of the CSE curriculum
During a pilot of the school programme last year, 4 sessions drawn from the Tuko Pamoja manual were used in the delivery of the health talks. This was effected within the scheduled Lifeskills course timeline in the schools. A manual containing the 4 sessions was compiled by the MSK marketing team and issued to the SHNs, PHOs and RHCs from the county teams who were tasked with its’ delivery. A review exercise of the pilot was held in April 2018 in the county of Mombasa where the key challenges and successes were discussed. One of the key challenges raised at the review was on the time it took to complete the four health talk sessions to a class in a school, which prompted the recommendation to reduce the sessions to 3 with a view of freeing up some time to enable the reach of more schools. In addition to this, most of the students had a tendency to question more on the sexuality subject even during the first session.
Currently, the 3-session curriculum in use is not comprehensive enough as it touches on a few subjects. The teachers in the public schools are also not knowledgeable enough in matters concerning reproductive health or empowered to teach the subject in the life skills course. Working with the MOH and MOE necessitated that we develop a holistic curriculum and our bias was on contraceptives. The use of contraceptive has been integrated across all the sessions.
The CSE is delivered through an integrated, interactive process, is age appropriate and localized to the counties. It does not use any elements of “Rote learning” and is taught as drawn from the original curriculum. The content borrows from some of the existing subjects such as Biology, CRE and lifeskills. It barely touches on the issues and a more enhanced content is now required. Below, find the structure of the current content.
The 3 session curriculum includes the following:
Values and interpersonal skills
Responsible sexual behavior
Building Healthy Relationships
Qualities of healthy romantic relationships
Challenges in Romantic Relationships
Skills to overcome challenges in romantic relationships
Sexual and reproductive physiology
Puberty/physical changes in the body
Define adolescence
List physical and emotional changes that happen during adolescence
Explain that sexual feelings are normal
Reproductive organs
Reproduction myths
Communicating
Healthy Relationships
Romantic relationships
Love and infatuation
Sexuality and behavior
Decision making
Teen pregnancy
Ways to prevent pregnancy
NOTE: We are riding on the school health programme at the counties. The current content has hence taken up components of this. The idea now is to engage in a more holistic content with SRH and contraceptives. This is to enable students make decisions on their SRH matters, drive contraceptive uptake leading to reduced pregnancy and school dropout incidents. Also note that Safe Abortion Care (SAC) is not covered in the current CSE.
Required: A revamped CSE curriculum
The CSE now requires delivery in a more effective manner to the students by the SHNs and the county teams of PHOs/RHCs, to ensure the project objectives and deliverables are met. Towards this, we require a curriculum developer to review the existing and select CSE curriculum content in the Tuko Pamoja manual and provide MSK with a revised version that will enable an easier, practical and consistent delivery to the recipient students. The selected content requires structuring such that it guides the teams delivering it to focus on the key messages and activity to aid in the learning. It hence needs to be further simplified and more engaging to provide learning with integrated activities, whilst ensuring it fits into the time allocated for the subject in the schools. The structure of the curriculum content should also enable a consistent and unified delivery of the key messages by all teams to ensure comprehension and positive behavior change and decision making in the long-run. The delivery should come out as soft, punchy and sweet, with a flow that is easy to grasp for both the moderators and the pupils. It is worthy of note that none of the moderators (School Health nurses, RHCs & PHOs) are trained educators, hence must be simple enough to do a quick Training-of-Trainers, to aid with its provision.
A document of the revised content and its delivery guideline is now necessary. It is believed with the revised curriculum, all the teams (SHNs & PHOs/RHCs) will deliver a more memorable CSE to the students in the 3 counties.
Required: Process, Deliverables and Timelines
Management of the Consultant
The successful consultant will report to the Calculus of Sex Project Director and will be required to collaborate with the Marketing team who developed the adapted CSE content from the original Tuko Pamoja curriculum.
Key Qualifications and Experience
Have the knowledge & experience of curriculum development for both Primary and Secondary students
Knowledge of the KICD curriculum especially around Lifeskills and Values for Class 6 up to Form 4. Some working experience with KICD will be an added advantage
Have working knowledge of MOE policies and KICD processes
Must be acquainted with the national ASRH policy, the school health programme policy
Have knowledge of various life skills curricula developed by other organizations. Key learning from their implementation would be essential.
Knowledge of the Pamoja Life-skills curriculum developed by PATH for schools will be an added advantage.
Hold a Master’s Degree in Education.
Have excellent written and oral communication skills and strong command of English and Kiswahili languages.
Duration of the assignment
The Curriculum Developer will have an estimated duration of 6 weeks from signing of contract, summarized as follows;
2 weeks to revise, revamp and compile the selected 3-session curriculum from the original Pamoja manual.
1 week for presentation, review and refinement
1 week to conduct pre-test of revised curriculum at a school and conduct / deliver TOT to MSK staff
1 week to participate in the training / sensitize and provide delivery skill tips to the SHNs and PHOs on the revamped curriculum in the 3 counties.
1 week to conduct follow up visits to observe SHN and PHOs in live school programme sessions, in each county.
Output
An enhanced training CSE pack (manual) that for use by the moderators.
· It should provide structure on the sessions or a scheme of work that highlights the key messages, activities, materials, teaching aids required and the expected outcomes
· Ensure that the CSE curriculum elements contained in the select sessions can be fully understood by the adolescents
· Incorporate gender components into the selected sessions to address harmful gender norms.
· Ensure each session can empower or motivate the adolescent recipient to seek counselling as well as ASRH services further to the health talk
A summarized handbook for use by the school principals and Guidance and Counselling (G&C) teachers.
· This should contain the key objectives
· Structure of the curriculum content
· How it will be delivered (snapshot)
An Out-of-school health talk delivery pack
· A guide into delivering a health talk to out-of-school youth at events that is 45 minutes to 1 hour in duration.
· This should be contraceptive focused, highly interactive and memorable.
Other Outputs
Provide the MSK team with TOT skills to deliver
Train / sensitize MSK SHNs and county PHOs/RHCs on the most effective delivery methods for the revamped curriculum.
Provide guideline and tips on how to conduct One-on-one sessions
Interested consultant to include as Annex:
CV outlining relevant experience
2 samples of the most recent related assignments (and/ or references for the same).
Consulting firm profile
Copy of PIN certificate, Copy of VAT Certificate (if applicable)
A contract will be issued to the successful applicant in accordance with MSK conditions for consultancy contracts. In the event that further information is required in relation to the application documents, MSK reserves the right to seek the required information without the need for calling for re-submission of applications.
