TEACHERS' ROLE IN FOSTERING THE IMPLEMENTATION

OF SCHOOL-BASED SEXUAL AND REPRODUCTIVE HEALTH

INTERVENTION STRATEGIES FOR ADOLESCENTS
The Case of Dodoma City, Tanzania

Hazibon Zisiko Mogereja

MA (Applied Social Psychology) Dissertation

University of Dar es Salaam
June 2024
TEACHERS' ROLE IN FOSTERING THE IMPLEMENTATION
OF SCHOOL-BASED SEXUAL AND REPRODUCTIVE HEALTH
INTERVENTION STRATEGIES FOR ADOLESCENTS
The Case of Dodoma City, Tanzania

By

Hazibon Zisiko Mogereja

A Dissertation Submitted in Partial Fulfilment of the Requirements for the

Degree of Master of Arts in Applied Social Psychology of the University of Dar
es Salaam

University of Dar es Salaam

June 2024
 i

CERTIFICATION

The undersigned certify that he has read and hereby recommends for examination by
the University of Dar es Salaam a dissertation titled: Teachers' Role in Fostering the
Implementation of School-based Sexual and Reproductive Health Intervention
Strategies for Adolescents: The case of Dodoma City, Tanzania, in partial fulfilment
of the requirements for the degree of Master of Arts in Applied Social Psychology of
the University of Dar es Salaam.

………………………………

Dr. Chris Mauki

(Supervisor)

Date: …………………….........
 ii

DECLARATION

AND

COPYRIGHT

I, Hazibon Zisiko Mogereja, hereby declare that this dissertation is my original

work, and it has not been presented and shall not be presented to any other
University for a similar or any other degree award.

Signature...………..................

This dissertation is a copyright material protected under the Berne Convention, the
Copyright and Neighbouring Rights Act of 1999 and other international and national
enactments, in that behalf, on intellectual property. It may not be reproduced by any
means, in full or in part, except for short extracts in fair dealings, for research or
private study, critical scholarly review or discourse with an acknowledgment,
without the written permission of the Director of Postgraduate Studies, on behalf of
both the author and the University of Dar es Salaam.
 iii

ACKNOWLEDGEMENT

With great humility, I am very grateful to the Almighty God for the gift of life and
the blessings he bestowed upon me to accomplish this research. I am also
exceptionally grateful to my beloved wife Debora for her love, support,
encouragement, and patience during the struggle to balance my home and school
responsibilities. I am greatly indebted to my parents Zawadi and Wema Zisiko, to my
grandmother Loyce, and to all my siblings whose love, hope, prayers,
encouragement, and unwavering support have lifted me from the depths of despair to
the great heights of hope. I also would like to acknowledge my best friends,
Godlisten Kundael, Zuberi Beatus, Paul Maisa, Ales Paul, and Brazil Japhet for their
incredible moral and material support. I could not have completed this research
without the grace of God, my diligence, my family, and friends' loyalty and patience.

I am very grateful to my supervisor Dr. Chris Mauki for his guidance,

encouragement, commitment, tolerance, and friendly supervision that contributed to
significant improvements in this research from the beginning to the end. My sincere
gratitude also goes to my internal reader Dr. Rushahu for her constructive insights
that have truly enriched this study. I am also grateful to my lecturers, Dr. Shukia, Dr.
Sima, Dr. Katabaro, and Dr, Mboya whose academic contributions made my journey
to pursue a master's degree in applied social psychology successful. I also would like
to acknowledge the University of Dar es Salaam, School of Education, Department
of Educational Psychology and Curriculum Studies for the review and approval of
the proposal of this research and the final dissertation report.

I would like to acknowledge the office of the director of Dodoma City and the head
of the secondary school division for granting me the permission to undertake this
research in Dodoma City secondary schools. I also extend my sincere gratitude to the
schools and teachers participated in this research, their cooperation and contributions
are deeply valued. I am also very grateful to my classmates especially Dezdel Tumbu
and Benard Rwegasira for their moral and material support. Finally, I would like to
thank everyone who played a role in the completion of this research, thank you so
much for your support. May God bless you all.
 iv

DEDICATION

This study is dedicated to all teachers in Tanzania to appreciate and recognise their
hard work, commitment, and contribution to the development of adolescents and the
young generation in schools. May God bless all teachers in a special way.
 v

LIST OF ABBREVIATIONS

AIDS Acquired Immune Deficiency Syndrome

CAG Controller Auditor General
CBOs Community Based Organizations
CSE Comprehensive Sexuality Education
CSOs Civil Society Organizations
EAC East African Community
ESA Eastern and Southern Africa
HIV Human Immuno Deficiency Virus
IFMSA International Federation of Medical Student Association
LSE Life Skills Education
MoEC Ministry of Education and Culture
MoEST Ministry of Education Science and Technology
MoEVT Ministry of Education and Vocational Training
MoH Ministry of Health
MoHCDGEC Ministry of Health Community Development Gender
Elderly and Children
NAIA-AHW National Accelerated Action and Investment Agenda for
Adolescents Health and Wellbeing
NGOs Non-Government Organizations
NSHP National School Health Programme
PORALG President's Office Regional Administration and Local
Government
SDGs Sustainable Development Goals
SRH Sexual and Reproductive Health
STDs Sexually Transmitted Diseases
STIs Sexually Transmitted Infections
UN United Nations
UNAIDS Joint United Nations Programme on HIV/AIDS
UNDESA United Nations Department of Economic and Social
Affairs
UNESCO United Nations Educational Scientific and Cultural
Organization
UNFPA United Nations Population Fund
UNICEF United Nations International Children's Emergency Fund
USAID United States Agency for International Development
WHO World Health Organization
YFHS Youth Friendly Health Services
 vi

LIST OF TABLES

Table 3.1 Children and Adolescents in Tanzania Cities ....................................... 26

Table 3.2 SRH Interventions Data in Dodoma City Secondary Schools .............. 29
Table 3.3 Purposeful Sampling Criteria for Selecting Schools ............................ 30
Table 3.4 Purposeful Sampling Criteria for Selecting Teachers ........................... 30
Table 3.5 Documents Reviewed ........................................................................... 30
Table 3.6 Six Stages of Thematic Analysis .......................................................... 32
Table 4.1 Schools' Demographic Information ...................................................... 35
Table 4.2 Teachers' Demographic Information..................................................... 36
 vii

LIST OF FIGURES

Figure 2.1 Ecological Factors Affecting Health ..................................................... 12

Figure 2.2 Ecological Systems ............................................................................... 13
Figure 3.1 Dodoma Region Map ............................................................................ 25
Figure 3.2 Levels of SRH Knowledge among Adolescents in Dodoma Region........... 27
 viii

LIST OF PICTURES

Picture 4.1 SS3 Civics Lesson Plan ..................................................................... 38

Picture 4.2 SS5 Dormitory Construction Project ................................................. 38
Picture 4.3 SS1 Biology Lesson Plan ................................................................... 41
Picture 4.4 SS2 School Health Strategic Plan ...................................................... 44
Picture 4.5 SS4 Student Science Club.................................................................. 49
Picture 4.6 SS2 Biology Scheme of Work ........................................................... 50
Picture 4.7 Guidelines for Selecting School Guardians/Counsellors ................... 54
Picture 4.8 SS5 Dormitory Construction Project Activities................................. 56
Picture 4.9 SS1 Teachers and Parents Meeting .................................................... 57
Picture 4.10 SS3 Peer Education Counselling Programme .................................... 61
 ix

ABSTRACT

Sexual and reproductive health (SRH) refers to the physical, emotional, mental, and
social well-being in relation to all aspects of sexuality and reproduction. The research
problem addressed by this study is the inadequate implementation of school-based
SRH intervention strategies for adolescents. The purpose of the study was to explore
the role of teachers in fostering the implementation of school-based SRH
intervention strategies for adolescents in Dodoma City secondary schools. Guided by
the ecological systems theory and informed by existing literature, the researcher
employed a qualitative research approach in a single instrumental case study design.
Five schools and twenty-five teachers were purposively involved in the study. Data
collection employed in-depth interviews and documentary review while data analysis
employed thematic analysis strategies. The study findings revealed that the
implementation of any school-based SRH intervention strategy in Dodoma City
secondary schools depends on the role of teachers in fostering the implementation
process at all levels of the ecological systems. However, inadequate interpretation of
school-based SRH policies and limited resources impair teachers' efforts. The study
findings contribute to a broader understanding of the role of teachers in fostering the
implementation of school-based SRH intervention strategies and to the improvement
of SRH and education among adolescents in schools. Based on the study findings the
researcher recommends responsible decision makers to utilize the role of teachers
effectively in the implementation of school-based SRH intervention strategies and
allocate school-based SRH intervention budgets and resources directly in schools to
reduce barriers and strengthen the capacity of teachers.
 x

TABLE OF CONTENTS

Certification...................................................................................................................i
Declaration and Copyright ........................................................................................... ii
Acknowledgement ...................................................................................................... iii
Dedication.............. ..................................................................................................... iv
List of Abbreviations ................................................................................................... v
List of Tables...............................................................................................................vi
List of Figures. ........................................................................................................... vii
List of Pictures .......................................................................................................... viii
Abstract.......................................................................................................................ix
Table of Contents.........................................................................................................x
CHAPTER ONE: INTRODUCTION ...................................................................... 1
1. Introduction ................................................................................................... 1
1.1 Background to the Problem........................................................................... 1
1.2 Statement of the Problem .............................................................................. 7
1.3 Purpose of the Study ..................................................................................... 7
1.4 Objectives of the Study ................................................................................. 8
1.5 Research Questions ....................................................................................... 8
1.6 Significance of the Study .............................................................................. 8
1.7 Delimitation of the Study .............................................................................. 9
1.8 Limitations of the Study.............................................................................. 10
1.9 Operational Definition of Key Terms ......................................................... 10
1.10 Organisation of the Study ........................................................................... 11
1.11 Chapter One Summary ................................................................................ 11
CHAPTER TWO: LITERATURE REVIEW ....................................................... 12
2. Introduction ................................................................................................. 12
2.1 Theoretical Framework ............................................................................... 12
2.2 The Role of Teachers in Implementing School-based SRH Intervention
Strategies for Adolescents........................................................................... 15
2.3 School-based Sexual and Reproductive Health Intervention Strategies ..... 16
2.4 Barriers Facing Teachers in the Implementation of School-based
SRH Intervention Strategies ....................................................................... 19
2.5 Empirical Studies ........................................................................................ 20
2.6 Synthesis and the Research Gap ................................................................. 23
2.7 Chapter Two Summary ............................................................................... 23
CHAPTER THREE: RESEARCH METHODOLOGY ...................................... 24
3. Introduction ................................................................................................. 24
3.1 Research Approach ..................................................................................... 24
3.2 Research Design .......................................................................................... 24
3.3 Description of the Study Area ..................................................................... 24
3.4 Sampling....................................................................................................... 28
3.5 Data Collection Methods ............................................................................ 31
3.6 Data Analysis Strategy ................................................................................ 31
 xi

3.7 Trustworthiness of the Study ...................................................................... 32

3.8 Ethical Considerations ................................................................................ 33
3.9 Chapter Three Summary ............................................................................. 33
CHAPTER FOUR: DATA PRESENTATION, ANALYSIS, AND
DISCUSSION OF THE STUDY FINDINGS ........................................................ 35
4. Introduction ................................................................................................. 35
4.1 Participants' Demographic Information ...................................................... 35
4.2 Data Presentation, Analysis, and Discussion of the Study Findings ........... 36
4.2.1 The Perceived Role of Teachers in Fostering the Implementation of
School-based SRH Intervention Strategies for Adolescents in Dodoma
City Secondry Schools ................................................................................ 37
4.2.2 Strategies utilised by Teachers to Implement School-based SRH
Interventions for Adolescents in Dodoma City Secondary Schools .......... 48
4.2.3 Barriers Facing Teachers in the Implementation of School- based
SRH Intervention Strategies for Adolescents in Dodoma City
Secondary Schools ...................................................................................... 62
4.2.4 Implications of the Study Findings ............................................................. 73
CHAPTER FIVE: SUMMARY, CONCLUSION, AND
RECOMMENDATIONS ......................................................................................... 75
5. Introduction ................................................................................................. 75
5.1 Summary of the study ................................................................................. 75
5.2 Summary of the Key Findings .................................................................... 75
5.3 Conclusion .................................................................................................. 77
5.4 Recommendations ....................................................................................... 78
REFERENCES ......................................................................................................... 80
APPENDICES .......................................................................................................... 88
 1

CHAPTER ONE
INTRODUCTION

1. Introduction

Various studies have revealed that the implementation of school-based sexual and
reproductive health intervention strategies for in-school adolescents is limited and
inadequate in many countries (Abbdurahman et al., 2022; Ngissa et al., 2024; Obach
et al., 2022; UNESCO, 2023). As a result, negative SRH outcomes persist among in-
school adolescents (United Nations Population Fund [UNFPA], 2023). In Tanzania,
the lack of effective coordination and implementation structure in local government
authorities and a lack of adequate documented evidence of SRH interventions in
schools have been reported as major barriers (Hakielimu, 2021; Ministry of Health
Community Development Gender Elderly and Children [MoHCDGEC], 2021b).

Therefore, the study aimed to document the case of Dodoma City, Tanzania by
exploring the role of teachers in fostering the implementation of school-based sexual
and reproductive health intervention strategies for adolescents in secondary schools.
Chapter one presents the introduction, background to the problem, statement of the
problem, purpose of the study, objectives of the study, research questions,
significance of the study, delimitations of the study, limitations of the study,
operational key terms, organisation of the study, and summary of the chapter.

1.1 Background to the Problem

Sexual and reproductive health among adolescents is a key factor for global
development progress, shaping demographic and public health trends. This is widely
recognised in the Sustainable Development Goals (SDGs) and the 2016-2030 Global
Strategy for Women’s, Children’s, and Adolescents' Health (WHO, 2018a). Children
and adolescents represent nearly half of the population of Tanzanian cities (United
Nations Children’s Fund [UNICEF], 2022) and half of the Tanzania total population
(Ministry of Finance and Planning [MoF], 2022a). Children (0 to 18 years old) and
youth (19 to 35 years old) have the potential to shape and influence development
progress in Tanzania (United States Agency for International Development
[USAID], 2020).
 2

Furthermore, according to WHO (2019) four out of every five of the world’s children
aged between 10 and 15 years are enrolled in lower secondary education, which is
compulsory in many countries including Tanzania. However, lower secondary school
completion rates in sub-Saharan Africa range from 43 percent for girls and 46
percent for boys due to negative SRH outcomes and low investment in teachers
(UNESCO, 2024). School settings and teachers have unique opportunities to provide
SRH literacy within formal education (UNESCO, 2023). Adequate implementation
of school-based SRH intervention strategies can enhance safe sexual behaviours;
reduce early marriages, early pregnancies, school dropouts, unsafe abortions, HIV
infections, and poverty among adolescents and their communities (UNICEF, 2021c).

Different countries and the international community organisations such as the United
Nations through the WHO, UNFPA, UNICEF, and UNESCO agencies have built on
this awareness to implement various intervention strategies to address negative SRH
outcomes among adolescents. In Africa, the Eastern and Southern Africa (ESA) The
Inter-ministerial Commitment on Comprehensive Sexuality Education and SRH
Services for Adolescents and Young People was signed by ministers of health and
education from 21 countries of the region (Tanzania included) in 2013 to enhance
systematic scale-up of CSE and youth-friendly SRH services in schools. However,
despite these commitments, adolescents' access to SRH knowledge, information, and
services in schools remains largely inadequate in the majority of ESA countries
(Keogh et al., 2020; UNESCO, 2021).

Globally, the consequences are alarming with high rates of child marriages, early
pregnancies, unsafe abortions, sexual violence, school dropouts, and projections of
HIV infections among adolescents in the coming decades (Joint United Nations
Programme on HIV/AIDS, [UNAIDS], 2021a; Khalifa et al., 2019; WHO, 2022).
The 2022 global AIDS update indicates that inadequate investment and action in
HIV prevention efforts poses a significant threat worldwide. The report revealed that
young people constitute approximately 70 percent of the global population living
with HIV (UNAIDS, 2022). Despite various comprehensive prevention projects
implemented in many countries, adolescent vulnerability to HIV infections is high
specifically among girls and young women aged 15 to 24 years (UNFPA, 2023).
 3

Furthermore, the WHO (2022) global report on adolescent pregnancies revealed that
each year approximately 21 million secondary school aged girls (15 to 19 years) in
developing regions become pregnant and around 12 million give birth. This is
associated with social and cultural factors such as societal pressure for girls to marry
and bear children. In 2021, there were 650 million child brides worldwide. In
addition, the global status report on preventing violence against children revealed
that approximately 120 million girls under the age of 20 have experienced some form
of forced intimate contact (WHO, 2020). The prevalence of sexual violence, early
pregnancies, and marriages among school girls indicate school-based SRH
intervention programmes are not sufficient.

In sub-Saharan Africa, a report by (the United Nations Department of Economic and

Social Affairs [UNDESA], 2022) revealed persistent high levels of adolescent
fertility in several countries with negative consequences for the health and well-being
of both young mothers and their children. In 2021, approximately 13.3 million babies
(10 percent of global births) were born to young girls under the age of 20 worldwide,
with half of these births occurring in sub-Saharan Africa (Tanzania included). It is
important to note that these young mothers should ideally be pursuing their education
in secondary schools. However, early motherhood disrupted their educational path
and ability to fulfil their potential.

Other studies have shown that existing SRH services in sub-Saharan Africa cannot
fully address SRH needs among adolescents (Obiezu-Umeh et al., 2021; WHO,
2024). Consequently, young people aged 10 to 24 years suffer from negative SRH
outcomes due to high-unmet needs and significant challenges in accessing SRH
services. On the other hand, multiple barriers in accessing SRH services among in-
school adolescents have been reported including a lack of awareness of where to get
services, lack of confidentiality and privacy, cost of services, distance, and negative
service provider attitudes. Furthermore, existing SRH services are technically
designed for adults (WHO, 2019). However the role of teachers in addressing these
challenges through school-based SRH intervention strategies is underutilised.
 4

In Eastern and Southern Africa, the regions with 70 percent of adolescents (aged 10
to 19 years) living with HIV globally, progress in reducing new HIV infections has
significantly slowed down due to increasing challenges in both domestic and
international funding. Consequently, in every three minutes one young woman
becomes infected with HIV (UNAIDS, 2022). Fortunately, Tanzania is among the
five selected countries that have achieved 95-95-95 targets in HIV/AIDS prevention,
treatment, and care (UNAIDS, 2023). However, despite these remarkable progress
adolescents in Tanzania secondary schools remains vulnerable to HIV infections due
to inadequate implementation of school-based SRH intervention strategies.

In Tanzania, various researches has indicated that adolescents in schools engage in

extremely risky sexual practices and behaviours due to a lack of knowledge, age-
appropriate information, and skills to make informed choices and decisions about
their sexual and reproductive health (Millanzi et al., 2022; Moshi & Tilisho, 2023;
Nkata et al., 2019; UNICEF, 2021c). Similarly, UNICEF (2019a) pointed high
prevalence of child marriages in Tanzania, highlighting almost one in three girls aged
20 to 24 were married or in a union before the age of 18. Furthermore, MoHCDGEC
(2018) reported high rates of adolescent fertility, STIs, and HIV/AIDS as the
consequences of low levels of SRH knowledge among adolescents. This indicates the
role of teachers in fostering the implementation of school-based SRH intervention
strategies is underutilised.

These challenges can disrupt the academic development of young boys and girls in
schools. Adolescents who became mothers are more likely to drop out of school
(MoH, 2022). A high number of school dropouts caused by early pregnancies among
girls in Tanzania secondary schools have been reported. The Controller and Auditor
General (CAG) report for the 2021/2022 financial year revealed that out of 42,954
impregnated school girls, 23,009 were from secondary schools accounting for 28
percent of 82,236 girls that were scheduled to complete their ordinary level
secondary education in 2022 (National Audit Office of Tanzania [NAOT], 2022).
This also indicates the role of teachers in reducing the rate of pregnancies and school
dropouts among girls in secondary schools is underutilised due to inadequate
implementation of school-based SRH intervention strategies.
 5

Other studies have revealed that Tanzania is among the ten countries with the highest
adolescent pregnancies globally (UNESCO, 2023). In Tanzania, abortion is illegal
unless it means to save life, and access to safe abortion services is limited. Pregnant
girls choose to drop out of school to avoid consequences such as social
discrimination, while other girls choose abortion to prevent school discontinuation
(Ito et al., 2022). However, even after Tanzania lifts the ban on teenage mothers
returning to school (MoEST, 2021) the challenge of addressing the educational
disruption caused by early motherhood requires a multifaceted approach to intervene
at all levels of the ecological systems in which the role of teachers is very crucial.

Furthermore, in Tanzania SRH interventions in secondary schools are relatively few

compared to the actual need (MoHCDGEC & MoEST, 2018). Teachers through
biology and civics implement SRH interventions in secondary schools. In biology,
teachers are required to teach a range of age-appropriate SRH topics that address the
physical, behavioural, emotional, and cognitive issues (see Appendix F). On the
other hand, SRH topics in civics address social, cultural, economic, and political
issues that cut across SRH among adolescents in schools (see Appendix G).
However, SRH education in secondary schools is not comprehensive to fight risky
sexual behaviours among adolescents (Ngissa et al., 2024). Consequently, many
adolescents in secondary schools remain vulnerable to negative SRH outcomes.

Tanzania has developed several policies, frameworks, and guidelines to address SRH
issues among adolescents including school-based SRH interventions. The National
Curriculum Framework for Basic and Teacher Education (2019); the National
Adolescent Health and Development Strategy (2018-2022); the National School
Health Programme (2018-2023); the National Multi-sectoral HIV/AIDS Strategic
Framework (NMSF IV-2017/18-2022/23); the National Accelerated Action and
Investment Agenda for Adolescent Health and Wellbeing (NAIA-AHW-2021/22-
2024/25); the National Health Sector Strategic Plan 2021-2026 (HSSP V); and the
National Plan For Reproductive, Maternal, New-born, Child and Adolescent Health
& Nutrition (2021/2022-2025/2026) One Plan III, to mention just a few.
 6

However, the implementation of these policies, guidelines, frameworks, and the

curricula do not engage the role of teachers adequately from paper to practice. Other
studies have revealed that the delivery of SRH contents in secondary schools through
biology and civics is inadequate (Ngissa et al., 2024; UNESCO, 2023). Furthermore,
formal guidance and counselling services, parental and community involvement
strategies are inadequate due to a lack of effective implementation strategies that
prioritize the role of teachers in the implementation process (Ito et al., 2022;
Mchuchury & Gwajekera., 2023). Consequently, adolescents in secondary schools
continue to suffer from school dropouts, early pregnancies, and HIV infections.

On the other hand, intervention programmes that aim at promoting adolescents'

health and well-being in Tanzania, lack effective coordination and implementation
structure to emphasize the role of teachers and local government authorities to make
more coordinated efforts at the grassroots level (MoHCDGEC, 2021b). Most barriers
to the implementation of adolescent SRH intervention strategies are recognised in
existing policies. However, very little information exists on how well these policies
and legislations are being implemented (MoHCDGEC, 2021c). As a result, teachers
remain less empowered in fostering the implementation of school-based SRH
intervention strategies. Teachers' insufficient knowledge in teaching SRH topics,
policy and skill gaps increase adolescents' vulnerability to negative SRH outcomes,
especially girls who epitomize the urban HIV/AIDS paradox (Mboneko & Iramba,
2022; MoHCDGEC, 2021a).

Furthermore, teachers' inadequate awareness of SRH policies, guidelines, and

evolving SRH issues among adolescents in Tanzania, results in inadequate response
and support needed to address daily SRH challenges among adolescents in schools
(Hakielimu, 2021). School-based SRH intervention programmes initiated by poorly
prepared and less informed teachers can be detrimental. Less skilled teachers can
deliver inaccurate information, produce values and attitudes that silence SRH
discussions or deliver SRH messages strongly influenced by their personal views and
experiences (UNESCO, 2021). To achieve a healthy and educated young generation,
the role of teachers in fostering the implementation of school-based SRH
intervention strategies is very crucial.
 7

The identified inadequacies, the underutilised role of teachers, and the prevalence of
the negative SRH outcomes among adolescents, have made this research important to
address the research problem in the case of Dodoma City, Tanzania. A better
understanding of the perceived role of teachers, strategies employed by teachers, and
the barriers facing teachers in the implementation of school-based SRH intervention
strategies, is very important towards implementing adequate SRH intervention
strategies for adolescents in Dodoma City secondary schools.

1.2 Statement of the Problem

Recent reports from the MoHCDGEC (2021c) and the Ministry of Health (2022)
indicated that the majority of adolescents in Tanzania lack adequate access to CSE
and SRH services. This contributes to early marriages, teenage pregnancies, unsafe
abortions, poor menstrual hygiene, STIs, low education attainment, and HIV/AIDS
among adolescents, where 40 percent of new infections occur in adolescents
(UNICEF, 2019b). Tanzania has made deliberate efforts and progress to implement
school-based SRH intervention strategies for adolescents in schools such as the
integration of CSE in secondary schools in 2005, the 2018 policy guidelines on
school health services, the integration of SRH content in teacher education in 2019,
and the 2021-2025 secondary education quality improvement project (SEQUIP).

However, despite efforts and the progress made by Tanzania, the implementation of
school-based SRH intervention strategies for adolescents in secondary schools
remains inadequate due to a lack of documented evidence in schools, ineffective
coordination and implementation structure in the local government authorities
(Hakielimu, 2021; MoHCDGEC, 2021b). Therefore, this study intended to document
the case of Dodoma City, Tanzania by investigating the role of teachers in fostering
the implementation of school-based SRH intervention strategies for adolescents in
secondary schools.

1.3 Purpose of the Study

The purpose of this research was to explore the role of teachers in fostering the
implementation of school-based sexual and reproductive health intervention
strategies for adolescents in Dodoma City secondary schools.
 8

1.4 Objectives of the Study

This research intended:

i. To explore the perceived role of teachers in fostering the implementation of
school-based sexual and reproductive health intervention strategies for
adolescents in Dodoma City secondary schools

ii. To examine strategies utilised by teachers to implement school-based sexual

and reproductive health interventions for adolescents in Dodoma City
secondary schools

iii. To investigate barriers facing teachers in the implementation of school-based

sexual and reproductive health intervention strategies for adolescents in
Dodoma City secondary schools

1.5 Research Questions

Based on the objectives of this study, the research questions were:

i. What is the perceived role of teachers in fostering the implementation of
school-based sexual and reproductive health intervention strategies for
adolescents in Dodoma City secondary schools?

ii. How do teachers implement school-based sexual and reproductive health

interventions for adolescents in Dodoma City secondary schools?

iii. What are the barriers facing teachers in the implementation of school-based
sexual and reproductive health intervention strategies for adolescents in
Dodoma City secondary schools?

1.6 Significance of the Study

The study findings inform and guide teachers in Dodoma City secondary schools to
deliver adequate and effective school-based SRH interventions. The active role of
teachers in fostering comprehensive sexuality education, parental and community
participation, guidance and counselling services, and peer education programmes
may increase adolescents' security and social support. This can reduce early
pregnancies and marriages, school dropouts, sexual violence, STIs, and HIV
infections among adolescents in Dodoma City secondary schools. Furthermore, the
 9

study has the potential to influence changes in adolescents' social and academic lives.
Eventually, it will lead to healthy, well-educated, developed, and responsible adults
in Dodoma City communities and other similar contexts in Tanzania.

The identified perceived role of teachers, strategies utilised by teachers, and barriers
facing teachers in the implementation of school-based SRH intervention strategies
for adolescents in Dodoma City secondary schools, contribute to a broader
understanding of the role of teachers in fostering the implementation of school-based
SRH intervention strategies for adolescents in schools. The study advocates for a
strategic focus by emphasising the centrality of the role of teachers in the
implementation of school-based SRH intervention strategies, which adds a new
knowledge and perspective to the existing literature.

Furthermore, the study findings will enable the government of Tanzania, school
administrations, educational authorities, policymakers, local government authorities,
and healthcare professionals to make evidence-based decisions and allocate school-
based SRH budgets directly in schools to address barriers facing teachers in the
implementation of school-based SRH intervention strategies. This will ensure
adequate SRH services in schools, effective resource mobilisation, and friendly
school environments for adolescents in Dodoma City secondary schools. Thus,
contributing to Tanzania and global efforts aimed at improving positive sexual and
reproductive health outcomes among adolescents.

1.7 Delimitation of the Study

To narrow down the scope and focus, the study was confined to the context of five
ordinary level secondary schools (3 government schools and 2 non-government
schools) in Dodoma City, Tanzania. The study also focused on secondary school
teachers with sexual and reproductive health knowledge, intervention experience,
and leadership. The study did not target teachers in primary schools or other aspects
of adolescents' health beyond the scope of school-based sexual and reproductive
health intervention strategies. Therefore, the findings of this study may not be
generalised to other teachers, schools, cities, regions, or countries.
 10

1.8 Limitations of the Study

The research budget, time, focus, methodological considerations, and the nature of
the study area, restricted the sample size of schools, teachers, and documents. The
initial plan targeted teachers and adolescents as primary participants. However,
during the research process it become essential to focus on teachers to maintain the
purpose of this research. However, these limitations led to in-depth exploration of
participants' views and experiences. Furthermore, the study findings are contextually
bound to Dodoma City and the specific characteristics of teachers involved in this
study, while this can limit the generalisability of the study findings, it ensured in-
depth exploration of the research problem within the study area which may serve as a
valuable case study for similar contexts.

1.9 Operational Definition of Key Terms

1.9.1 The Role of Teachers

In this study refers to the collective responsibilities that teachers as a group undertake
in fostering the implementation of school-based SRH intervention strategies.

1.9.2 Implementation

In this research refers to formal processes of putting into action SRH intervention
strategies in secondary schools.

1.9.3 School-based Sexual and Reproductive Health Interventions

In this study refer to programmes implemented in secondary schools to promote

sexual and reproductive health among adolescents.

1.9.4 Intervention Strategies for Adolescents

In this research refer to designed age-appropriate health plans of action and services
such as comprehensive sexuality education, guidance, and counselling.

1.9.5 Adolescents

In this study refer to secondary school students aged between 12 and 18 years.
 11

1.10 Organisation of the Study

The study report is divided into five chapters. Chapter one presents an introduction to
the research problem, background to the problem, statement of the problem, purpose
of the study, specific objectives, research questions, significance of the study,
delimitation of the study, limitations of the study, operational definitions,
organisation of the study, and summary of the chapter.

Chapter two presents the literature review, highlighting the theory underpinning this
study; the role of teachers, strategies utilised by teachers, and barriers facing teachers
in the implementation of school-based SRH intervention strategies, empirical studies,
synthesis and the research gap, and a summary of the chapter.

Chapter three presents the research methodology, highlighting the study approach
and design, description of the study area, the target population, sample size, sampling
techniques, sampling procedures, data collection methods, data analysis strategies,
trustworthiness of the study, ethical considerations, and summary of the chapter.

Chapter four covers the presentation, analysis, and discussion of the study findings,
implications of the study findings, and summary of the chapter.

Chapter five presents the study summary, conclusion, and recommendations.

1.11 Chapter One Summary

Chapter one has presented the introduction, background to the research problem,
statement of the problem, purpose of the study, specific objectives, research
questions, significance of the study, delimitation of the study, operational definitions,
and organisation of the study.
 12

CHAPTER TWO
LITERATURE REVIEW

2. Introduction

Chapter two presents the theory underpinning this study, the role of teachers in
school-based SRH interventions, school-based SRH intervention strategies, barriers
facing teachers in the implementation of school-based SRH intervention strategies,
empirical studies, synthesis and the research gap.

2.1 Theoretical Framework

The study was guided by the Ecological Systems Theory. This theory refers to a
comprehensive and a multifaceted child development framework developed by
Bronfenbrenner (1979) to examine social systems in which individuals and
communities exist. Bronfenbrenner (1979) emphasised that the physical, social, and
cultural dimensions of the environment influence an individual’s health status,
psychological well-being, and social cohesion. The theory identifies ecological
factors affecting health as individual factors, interpersonal factors, organisational
factors, community factors, and societal factors. As shown by the Figure below;

Figure 2.1 Ecological Factors Affecting Health

Societal
Culture, policies, laws

Community
Groups, organizations, institutions

Organisational
Environments, systems, servises

Interpersonal
Formal & informal relationships

Individual
Age, gender, knowledge, attitude, skills

Source: Bronfenbrenner (1979) and Field Data (2024)

 13

These factors can either enhance or hinder sexual and reproductive health among
adolescents. The factors are interconnected and operate across five multiple system
levels (the microsystem, the mesosystem, the exosystem, the macrosystem, and the
chronosystem), affecting individual adolescents in diverse ways based on their
cumulative experiences. Teachers can play a role in influencing the positive interplay
of these factors in through systemic school-based SRH intervention programmes at
all levels of the ecological systems (see Figure 2.2).

Figure 2.2 Ecological systems

Chronosystem
Changes over time (eg.technology)

Macrosystem
Social, political, & economic conditions

Exosystem
Formal & informal relations

Mesosystem
Immediate interactions & relationships

Microsystem
Immediate physical & social environment

Source: Brenfenbrenner (1979) and Field Data (2024)

The microsystem encompasses the immediate physical and social environment of

adolescents such as the home and school environment. The theory recognises the
influence of the immediate surroundings on adolescents' health in which teachers
play a significant role in fostering the implementation of school-based SRH
intervention strategies by influencing adolescents' home and school life.

The mesosystem involves immediate interactions and relationships between

adolescents and fellow students, teachers, parents, family, and community members.
The theory recognises the influence of these interactions and relationships on
adolescents' health and well-being. Teachers can play a role in designing and
 14

implementing school-based SRH intervention programmes that influence positive

SRH interaction and relationships between adolescents and their mesosystems.

The exosystem refers to formal and informal structures of the mesosystems such as
parents' friends, relatives, peers, neighbourhoods, housing, and social networks.
Teachers can design and implement school-based SRH intervention programmes that
shape adolescents' perceptions and behaviours beyond their immediate relationships.

The macrosystem refers to the larger societal forces that influence sexual and
reproductive health among adolescents. This include the social, political, and
economic conditions shared by society members, such as socio-cultural norms,
traditions, customs, values, beliefs, laws, public health policies, funding, and
budgeting. Teachers can influence broader systemic changes by developing school-
based SRH interventions that address the social, economic, and political barriers.

The chronosystem refers to changes in systems over time that influence individual,
community, and societal development such as technological advancements, changes
of political systems, policy changes, wars, natural disasters, and humanitarian
emergencies such as the Covid-19 pandemic. Teachers can influence the ecological
systems to remain effective against uncertainties over time.

The theory recognizes how changes in one system can affect development in other
systems, providing insights into the factors influencing adolescents' health and
informing intervention strategies from the individual teacher-student level (micro
systems) to the public health policy influence (macro systems). It also emphasizes
the importance of comprehensive and holistic support systems from the microsystem
(home/school) to the macrosystem (public health policies) and the chronosystem that
accommodates changes in systems over time. The theory informs about systematic
barriers, intervention strategies, and how teachers can play a role to foster the
implementation of school-based sexual and reproductive health intervention
strategies for adolescents.
 15

2.2 The Role of Teachers in Implementing School-based SRH Intervention

Strategies for Adolescents

Teachers hold a strategic responsibility to care for adolescents in schools including

promoting sexual and reproductive health. This is recognised in national and
international educational policies (MoHCDGEC & MoEST, 2018; UNESCO, 2018).

2.2.1 Teaching Comprehensive Sexuality Education

Teachers hold a significant position in implementing curriculum-based SRH

intervention strategies such as teaching comprehensive sexuality education,
imparting the physical, cognitive, emotional, and social aspects of SRH literacy
among adolescents in schools. Teachers have unique opportunities to shape SRH
knowledge, attitudes, behaviours, and lifestyles among in-school adolescents. They
can provide accurate and comprehensive information about SRH issues to students.
This can ultimately reduce unintended pregnancies, unsafe abortions, and school
dropouts (UNESCO, 2021).

2.2.2 Enhancing Parents and Community Participation

In the implementation of school-based SRH interventions, teachers play a significant

role in consolidating parents and community participation. Teachers raise parents'
awareness and engage adolescents' communities in resource mobilisation, joint
efforts, and structured collaborations that may result in SRH service provisions in
schools (MoHCDGEC & MoEST, 2018).

2.2.3 Advocating for School-based SRH Interventions

Teachers can advocate for adequate implementation of SRH intervention strategies

within schools and in the wider community, influencing school-based SRH policy
and cultural changes that may yield positive social, economic, political, and
academic outcomes among in-school adolescents. They can refer students to other
resources in the community where they can access SRH services, such as clinics or
youth-friendly health centres. Teachers can advocate for SRH interventions within
the school and the community (Chavula et al., 2021)
 16

2.3 School-based Sexual and Reproductive Health Intervention Strategies

Sexual and reproductive health interventions in schools involve a multi-disciplinary

approach. Professionals from different fields, including teachers, nurses, doctors,
social workers, and psychologists among others, are involved in implementing
interventions in this area (International Federation of Medical Students' Association
[IFMSA], 2022). Intervention strategies such as school-based health centres,
comprehensive sexuality education, peer education, contraception counselling and
provision, STIs prevention and care, HIV/AIDS prevention and care, parental and
community involvement have been recommended as effective strategies in
promoting SRH among adolescents (WHO, 2018b). Specific interventions employed
may vary worldwide based on contextual factors (Vincent & Krishnakumar, 2022).

2.3.1 School-Based Health Centres (SBHC's)

The presence of health centres within school settings has demonstrated positive
effects on adolescents, including increased satisfaction with their health and
improved adherence to health-promoting behaviours. However, not all countries have
school-based health centres as part of their health and education systems. These
centres have been shown to enhance adolescents' access to healthcare services by
addressing barriers such as availability, accessibility, acceptability, costs,
transportation, confidentiality, and privacy concerns (Abbudurahman et al., 2022).

2.3.2 Comprehensive Sexuality Education (CSE)

Comprehensive Sexuality Education refers to a curriculum-based and age-

appropriate process of teaching and learning about various dimensions of sexuality
including cognitive, emotional, physical, and social aspects. The primary objective of
comprehensive sexuality education is to provide children and young people with the
necessary knowledge, attitudes, skills, and values to enable them to make informed
decisions, develop self and social respect, to achieve healthy communication and
relationships with others. Comprehensive sexuality education is widely used in
educational curriculums to promote SRH knowledge among adolescents (United
Nations Educational, Scientific and Cultural Organisation [UNESCO], 2018).
 17

2.3.3 Peer Education

Peer education is the process of sharing knowledge and experiences among members
of a group who have similar concerns and characteristics. Peer education in the
school context is an approach in which students are trained as peer educators to
educate their peers on various sexual and reproductive health issues. It operates on
the premise that peers within their networks can effectively influence the knowledge,
attitudes, and behaviours of their peers (Akuiyibo et al., 2021). Peer education is
widely used as an intervention strategy to promote sexual and reproductive health
among adolescents in schools (Ito et al., 2022).

2.3.4 Contraception Counselling and Provision

Contraception involves the deliberate use of methods, either artificial or natural, to

prevent pregnancy. Adolescent pregnancies carry significant health and socio-
economic consequences. Health, complications arising from pregnancy and
childbirth are the leading cause of death and disability among girls aged between 15
and 19 years globally, with low and middle-income countries accounting for 99
percent of global maternal deaths of women aged between 15 and 49 years (WHO,
2022). Socio-economic consequences include school dropouts, early marriages, and
poverty. Contraception counselling and provision is highly recommended as an
effective strategy to reduce the rate of early pregnancies among adolescents.

2.3.5 STI Prevention and Care

Sexually transmitted infections (STIs) refer to infections caused by various bacteria,

viruses, and parasites transmitted through sexual contact. There are more than 30
microorganisms that can cause STIs (WHO, 2018a). STIs can cause discomfort, pain,
and have long-term consequences beyond the immediate infection. Curable STIs,
such as herpes, syphilis, chlamydia, gonorrhoea, and trichomoniasis increase the risk
of acquiring viral hepatitis and HIV (WHO, 2024). STIs screening, early treatment,
and prevention are highly recommended (WHO, 2018b). Effective STIs prevention
and care services for adolescents include the provision of human papilloma virus
(HPV) vaccination and scale-up of STIs case management (WHO, 2024a).
 18

2.3.6 HIV/AIDS Prevention and Care

HIV among adolescents is an important problem particularly in East and South

Africa, the regions with the highest HIV prevalence rates where in every three
minutes one young woman becomes infected with HIV (UNAIDS, 2022). HIV
viruses specifically target the immune system, weakening the body's ability to fight
against infections. The primary transmission of HIV viruses is through the exchange
of infected body fluids like blood, breast milk, semen, and vaginal secretions.
Currently, there is no cure or vaccine for HIV/AIDS. Untreated or undiagnosed HIV
infection can lead to high mortality rates. Effective interventions for HIV prevention
among adolescents include the provision of comprehensive sexuality education, HIV
testing, and voluntary counselling services (WHO, 2018b).

2.3.7 Youth Friendly Health Services (YFHS)

Youth-friendly services are services designed strategically to overcome barriers

within the healthcare systems by creating environments that are accessible, reliable,
acceptable, equitable, appropriate, and effective for young people. YFHS includes
guidance and counselling, referrals, HIV counselling and testing, STIs screening and
treatment. The goal is to ensure young people receive the necessary tools, support,
and information to make informed decisions about their sexual and reproductive
health (WHO, 2018a; Obiezu-Umeh et al., 2021).

2.3.8 Parental and Community Involvement (PCI)

Parental and community involvement is the interaction between schools, families,

and the wider community in the educational lives of their children (Bondiner, 1969).
Parents and community members play a vital role in the formation of each
subsequent generation. The physical, emotional, social, and intellectual components
of every human being have been determined to some extent by the influences of
parents or parent substitutes. On the other hand, each community school becomes a
coordinating source of community cooperative efforts and shared social
responsibilities. Therefore, the involvement of parents, families, and community
members is great in public health programmes that promote adolescents' sexual and
reproductive health (Abraha, 2022; Kishaluli & Mollel, 2023).
 19

2.4 Barriers Facing Teachers in the Implementation of School-based SRH

Intervention Strategies

Common barriers facing teachers towards implementing SRH intervention strategies

in schools include insufficient SRH training among teachers, inadequate access to
SRH services in schools, and insufficient funding (Chidwick et al., 2022).

2.4.1 Insufficient SRH Training among Teachers

Scholars have shown that implementation of health-related curricula have little

chance of success in schools where teachers lack adequate training and motivation
(Chavula et al., 2022; Chidwick et al., 2022). In Tanzania for example, teachers are
not trained to deliver content on health and wellbeing; comprehensive sexuality
education is not fully integrated in secondary school curriculum. Textbooks and
learning materials are in short supply in secondary schools. Schools lack health care
facilities and supply of key commodities such as contraceptives to promote good
menstrual hygiene management (Millanzi et al., 2022; WHO, 2019).

2.4.2 Inadequate Access to SRH Services

Inadequate healthcare services in schools and communities deny adolescents

(especially girls) access to contraception counselling and provision. It also deters
efforts to reduce early pregnancies and promotion of good menstrual hygiene, which
requires adequate access to water and accessible, private, and hygienic sanitation
facilities (Millanzi et al., 2022). Young adolescents in Tanzania ordinary level
secondary schools have no access to SRH services in community health centres. As a
result, many adolescents engage in risky sexual behaviours (WHO, 2019).

2.4.3 Insufficient Funding

Studies have shown that lack of financial resources due to insufficient funding is a
barrier facing teachers in the implementation of school-based SRH intervention
strategies for in-school adolescents (Mboneko & Iramba, 2022). Funding has been
unpredictable, disjointed, and sometimes withdrawn. Some countries have not
prioritised funding SRH interventions in schools (UNAIDS, 2023). This hurts the
implementation of school-based SRH intervention strategies (UNESCO, 2021).
 20

2.5 Empirical Studies

Various empirical studies surrounding the implementation of school-based sexual

and reproductive health intervention strategies for adolescents globally, in Africa,
and Tanzania have guided this study. These studies have significantly presented a
broader knowledge and comprehensive understanding of the research problem.

2.5.1 Empirical Studies on the Implementation of School-based SRH

Intervention Strategies Globally

The global quantitative and qualitative data from UNAIDS (2021b) indicate that
among the 137 countries that provided information between 2017 and 2021, 81
percent reported having educational policies that align with international standards
for delivering life skills and comprehensive sexuality education in secondary schools.
Overall 62 percent of the countries reported having these policies in both primary
and secondary schools. However, the data highlights the prevalence of negative SRH
outcomes among in-school adolescents and inadequate resources allocated to
facilitate school-based SRH interventions in most regions. UNAIDS emphasised the
need for cost-effective implementation approaches without highlighting the role of
teachers in fostering the implementation of school-based SRH intervention strategies.

The global status report by UNESCO (2021) on the journey towards comprehensive
sexuality education indicated that 85 percent of 155 countries surveyed have policies
or laws related to sexuality education, with more countries reporting policies to
mandate the delivery of comprehensive sexuality education in secondary school than
primary schools. However, the existence of policy and legal frameworks does not
equate to comprehensive content or strong implementation efforts. Most countries
report some curricula in place but a more detailed analysis suggests a lack of
comprehensive topics needed to make sexual and reproductive health education
effective and relevant. The report focuses on the role of laws and policies without
emphasising the interventional role of teachers in fostering the implementation of
comprehensive sexuality education strategy in schools.
 21

The global education monitoring report by UNESCO (2023) on comprehensive

sexuality education country profiles revealed that most countries implement CSE
curricula that often lack comprehensive topics needed to make SRH education
effective and relevant. In addition, the report indicated that many countries have
weak implementation efforts without budgets for school-based SRH interventions.
Furthermore, the report revealed that Tanzania has weak levels of responsibility,
decentralisation, and autonomy regarding the implementation of school-based SRH
intervention strategies, while data about budget allocated for SRH interventions in
schools were not found. The study focused on the implementation barriers without
highlighting the cost effective role of teachers in school-based SRH interventions.

2.5.2 Empirical Studies on the Implementation of School-based SRH

Intervention Strategies in Africa

A quantitative study by UNICEF (2021b) on HIV and AIDS in adolescents revealed

an increase in HIV infections among adolescents and young people. In 2020, there
were 410,000 new HIV infections among young people aged 10 to 24; with 150,000
of these infections, occurring in adolescents aged 10 to 19 (secondary school age).
Furthermore, the data revealed that in Eastern and Southern Africa the region most
affected with HIV, in 2021 only 25 percent of adolescent girls and 17 percent of
adolescent boys have been tested for HIV and received their test results. UNICEF
warns that if the current trends continue, more adolescents will become HIV positive
in the coming years. However, the report did not emphasise the role of teachers in
school-based SRH interventions that aim to secure adolescents from HIV infections.

A systematic review conducted by Ninsiima et al. (2021) indicated various factors

influencing access to and utilisation of youth-friendly SRH services in sub-Saharan
Africa. The review analysed studies published between January 2009 and April 2019.
The findings highlighted several SRH challenges facing adolescents in the region.
One of the main challenges identified was the limited access to youth-friendly health
services. Consequently, adolescents in sub-Saharan Africa engage in risky sexual
behaviours, leading to high prevalence rates of early pregnancies, STIs, and HIV
infections among adolescents. The study highlights the challenges facing adolescents
 22

with little emphasis on the role of teachers in fostering the implementation of school-
based SRH intervention strategies.

A qualitative study conducted by Chidwick et al. (2022) with a focus on adolescent

engagement in sexual and reproductive health research in East Africa (Kenya,
Rwanda, Tanzania, and Uganda) found slow progress in achieving SDGs and targets
related to adolescents SRH in East Africa. Consequently, adolescents in East Africa
suffer from a continued burden of unmet contraceptive needs, inadequate SRH care
and school dropouts. One of the reasons for this slow progress is the complexity of
defining adolescent SRH priorities and the lack of sufficient research evidence to
support adolescent SRH policies and intervention decisions. The study did not
emphasise the role of teachers in fostering school-based SRH intervention strategies
to enhance effective SRH research, policies, and programmes in schools.

2.5.3 Empirical Studies on the Implementation of School-based SRH

Intervention Strategies in Tanzania

Moshi and Tilisho (2023) conducted a community-based analytical study focusing on

the magnitude of adolescent pregnancy and its associated factors among adolescents
in the Dodoma region. The study included a sample of 539 secondary school age
adolescent girls aged 15 to 19 years old. Findings revealed a high prevalence of
adolescent pregnancy in the Dodoma region. The study highlighted that adolescents
in Dodoma City are more vulnerable to teenage pregnancies due to low SRH
knowledge. Based on their study findings, the researchers recommended the need for
a cost-effective interventional study. However, the study did not highlight the role of
teachers in implementing school-based SRH intervention strategies as a cost-
effective strategy to address early pregnancies among adolescents.

Millanzi et al. (2022) conducted a school-based randomised controlled trial in the

Dodoma and Lindi regions of Tanzania to assess the effects of integrated SRH lesson
materials in a problem-based pedagogy on soft skills for safe sexual behaviours
among adolescents. The study revealed that teachers experience pedagogical
difficulties in facilitating the psychological part of SRH teaching and learning
materials such as ways to control sexual outbursts and how to deal with sexual
 23

violence using conventional pedagogies. The study findings further revealed that
problem-based pedagogy significantly influences safe sexual behaviours among
adolescents. However, the study highlights the pedagogical role of teachers without
emphasising the role of teachers in fostering adequate implementation of school-
based SRH intervention strategies.

The World Health Organisation (2019) conducted a qualitative study in the United
Republic of Tanzania to assess barriers to adolescent health services. The study
findings revealed that adolescents in day and boarding schools often face challenges
in finding peers or healthcare providers with whom they can discuss SRH issues
openly. The WHO research further revealed that health workers lack adequate
training and resources to deliver high-quality services to adolescents due to heavy
workloads and competing priorities. The study also identified boys and the disabled
as underserved populations among adolescents in schools and the lack of important
SRH services for adolescents in healthcare facilities. However, the study did not
emphasise the role of teachers in fostering school-based SRH intervention strategies.

2.6 Synthesis and the Research Gap

Literature review has revealed that the implementation of school-based SRH

intervention strategies for adolescents is inadequate. However, despite the strategic
recognition of teachers as key stakeholders in fostering the implementation of
comprehensive sexuality education, school guidance and counselling services, peer
education, parental and community involvement; the role of teachers is underutilised
in the existing literature highlighted in this study. Therefore, to address this gap the
study aimed to document the case of Dodoma City, Tanzania through in-depth
exploration of the role of teachers in fostering the implementation of school-based
SRH intervention strategies for adolescents in Dodoma City secondary schools.

2.7 Chapter Two Summary

Chapter two has presented the literature review on the implementation of school-
based SRH intervention strategies, highlighting the theory underpinning this study,
the role of teachers, school-based SRH intervention strategies, barriers facing
teachers, empirical studies, synthesis, and the research gap.
 24

CHAPTER THREE
RESEARCH METHODOLOGY
3. Introduction

This chapter presents the research approach, research design, description of the study
area, targeted population, sampling, data collection methods, data analysis strategies,
trustworthiness of the study, and ethical considerations.

3.1 Research Approach

The study utilised a qualitative research approach. According to Creswell & Creswell
(2018), qualitative research approach focus on understanding the meaning
individuals or groups attribute to social phenomena in their natural environments.
The qualitative research approach suited well the study as it enabled a contextual
understanding of the research problem and in-depth exploration of teachers'
interpretations and experiences regarding their role, strategies, and barriers in the
implementation of school-based SRH intervention strategies in Dodoma City
secondary schools.

3.2 Research Design

The study utilised a single instrumental case study design, which focus on in-depth
investigation of a broader phenomenon in one bounded case (Stake, 1995). As
emphasised by Yin (2018), Creswell and Poth (2018) a single instrumental case
study involves a comprehensive exploration of the research problem through an in-
depth examination of a case in its real-life context by involving multiple sources of
information and multiple methods of data collection such as in-depth interviews and
documentary review. The study case was Dodoma City, which served as an
instrument of analysis to gain a broader understanding of the research problem.

3.3 Description of the Study Area

The study area was Dodoma City, Tanzania. Dodoma City is located in the Dodoma
region and it serves as the Capital City of the United Republic of Tanzania. The city
spans approximately 2,669 square kilometres with a population of over 765,179, as
reported in the 2022 population and housing census (MoF, 2022b).
 25

Figure 3.1 Dodoma Region Map

Source: MoF (2022b)

 26

According to the (President’s Office Regional Administration and Local Government

[PORALG], 2020) there are 56 secondary schools in Dodoma City, consisting of 38
government schools and 18 non-government schools with over 1,724 qualified
teachers and 30,757 students. These educational institutions and their human
resource play a significant role in the growth and development of the city’s young
population.

The selection of Dodoma City as a case for this study was guided by four reasons:

The first reason is the number of children and adolescents. Dodoma City holds a
significant number of children and adolescents worthy of this research compared to
other Cities in Tanzania. Data from UNICEF (2022) indicates that children and
adolescents make up nearly half the population of Dodoma City (49 percent) this
percentage is higher than in other major Cities in Tanzania, such as Mbeya, Mjini
Magharibi, Dar es Salaam, and Mwanza (see Table 3.1 below)

Table 3.1 Number of Children and Adolescents in Tanzania Cities

Number of Children Total Urban Population
S/n City
& Adolescents Percentage
1. Dodoma 263,005 49
2. Mbeya 243,295 48.6
3. Mjini-Magharibi 352,033 48
4. Dar es Salaam 2,347,989 43.5
5. Mwanza 515,288 43

Source: UNICEF/Tanzania (2022) and Field Data (2024)

Similarly, (African Development Bank [AfDB], 2021) indicated that the shift of the
government administration functions from Dar es Salaam to Dodoma City has
created a significant population increase which presents challenges that increase
vulnerability for many communities. The substantial presence of children and
adolescents in Dodoma City established a potential intervention research interest in
addressing SRH issues among adolescents in Dodoma City secondary schools.

The second reason is low levels of SRH knowledge among adolescents in Dodoma
City compared to other districts in the Dodoma region. A study conducted by Moshi
and Tilisho (2023) in the Dodoma region found that adolescents in Dodoma City
 27

possess very low levels of SRH knowledge compared to Bahi, Chamwino, and
Chemba districts (see Figure 3.2) below;

Figure 3.2 Levels of SRH Knowledge among Adolescents in Dodoma Region

100.0% Good Poor

69.4%
56.3%
47.4% 52.6% 50% 50% 43.7%
50.0% 30.6%

0.0%
Bahi Chamwino Chemba Dodoma City

Source: Moshi and Tilisho (2023) and Field Data (2024)

This indicated the need for a school-based SRH intervention study such as this.

The third reason is the high prevalence rates of adolescent pregnancies in Dodoma
City secondary schools compared to other districts in Tanzania. In 2020, Dodoma
City was the second among 184 districts assessed in Tanzania, having 96 cases of
school dropouts due to early pregnancies (PORALG, 2020). Similarly, MoHCDGEC
(2021b) reported a high prevalence of teenage pregnancies in the Dodoma region,
while noting SRH programmes in the region do not reach a substantial number of in-
school adolescents. This indicates that the study on the role of teachers in fostering
the implementation of school-based SRH intervention strategies was inevitable.

The fourth reason is the unique role of Dodoma City. Being the Capital City of the
United Republic of Tanzania, Dodoma City holds a distinct position among other
cities in Tanzania as a strategic hub of Tanzania politics and national leadership. The
political influence and administrative power of Dodoma City has a unique role in
shaping and influencing the implementation of school-based SRH intervention
strategies. Any successful school-based SRH intervention strategy in Dodoma City
has the potential to be scaled up and replicated in other regions of Tanzania and other
countries in the region.
 28

3.4 Sampling

Sampling involves the selection of a subset of the population that will provide the
necessary information required by the researcher. It is a crucial step in a research
project as it is often impractical, inefficient, or unfeasible to study the entire
population (Creswell & Creswell, 2018).

3.4.1 Target Population

The target population is the population from which the sample is drawn (Ary et al.,
2012). The target population for this study was teachers in Dodoma City secondary
schools. The rationale for targeting teachers is rooted in the national and international
recognition of teachers as key stakeholders in implementing school-based SRH
intervention strategies. In the Tanzania education system, teachers are typically
responsible for implementing sexual and reproductive health intervention strategies
such as comprehensive sexuality education, parental and community involvement,
peer education, guidance, and counselling. Teachers are also responsible to initiate
SRH intervention programmes in schools and to foster the implementation of other
school-based SRH intervention programmes delivered by other service providers.

The decision to target teachers was informed by the International Technical

Guidance on Sexuality Education (UNESCO, 2018), the 2018-2023 National Policy
Guidelines on School Health Services in Tanzania (MoHCDGEC & MoEST, 2018),
the biology and civics syllabus for ordinary secondary education (Ministry of
Education and Vocational Training [MoEVT], 2005a, 2005b), the National
Curriculum Framework for Basic and Teacher Education (MoEST, 2019), and the
2021-2025 National Accelerated Action and Investment Agenda for Adolescent
Health and Wellbeing (MoHCDGEC, 2021b).

3.4.2 Sampling Technique

The study utilised a criterion purposive sampling technique, which involves selecting
a sample based on specific predetermined criteria or characteristics (Creswell &
Creswell, 2018). This technique enabled a focused selection of schools that best fit
the nature of the research problem and objectives, teachers with knowledge and
experience in implementing school-based SRH intervention strategies as well as
 29

school-based documents that provide in-depth insights and relevant information that
fit the research objectives/questions.

3.4.3 Sample Size

The study involved a sample size of 5 ordinary level secondary schools, 25

secondary school teachers, as well as institutional documents related to the
implementation of school-based SRH intervention strategies for in-school
adolescents. The sample size of 5 schools and 25 teachers was guided by the research
approach, design, and objectives. As informed by Creswell and Creswell (2018) in a
qualitative case study a relatively small sample can yield quality and in-depth data
depending on methodological rigour, data accuracy, and saturation point.

3.4.4 Sampling Procedures

The selection process of teachers, schools, and documents was as follows:

3.4.4.1 Schools. Following the field research permit, informed consent, sampling
technique, and willingness to participate, 5 schools out of 56 ordinary-level
secondary schools in Dodoma City were involved in the study (3 government and 2
non-government schools). The selection of the 5 schools was informed by PORALG
(2020) regional education data review and evaluation based on information related to
schools with a high number of adolescents, SRH trained teachers, pregnancy cases,
HIV/AIDS intervention programmes, and vulnerability (see Tables 3.2-3.3).

Table 3.2 SRH Interventions Data in Dodoma City Secondary Schools

prevention of HIV
training to parents
about HIV /AIDS
staff and students

Schools provided

Schools provided

Schools provided

on HIV and SRH

who are teaching

who are teaching

education on life
skills in general

trained teachers

trained teachers
implementing a

SRH education
programme on
guidelines for

infection and
Schools with

Schools with

Schools with
education on
reproductive
No of schools

HIV/AIDS

education
Schools
Council

health
of schools

of schools

of schools

of schools

of schools

of schools
of schools
Number

Number

Number

Number

Number

Number

Number
Percent

Percent

Percent

Percent

Percent

Percent

Percent

Dodoma 56 29 51 40 71 52 94 51 92 29 52 24 43 21 38
City

Source: PORALG (2020) and Field Data (2024)

 30

Table 3.3 Purposive Sampling Criteria for Selecting Schools

School Code School Category Mode Sampling Criteria
SS1 Government Day Number of adolescents
SS2 Non-government Day SRH trained teachers
SS3 Government Day Pregnancy cases
SS4 Non-government Day HIV/AIDS interventions
SS5 Government Day Vulnerability

Source: Source PORALG (2020) and Field Data (2024)

3.4.4.2 Teachers. Twenty-five secondary school teachers were involved in the

study. With the assistance of academic masters and heads of secondary schools in
Dodoma City, teachers with SRH knowledge/training, experience in teaching SRH
topics, and leadership role in school-based SRH interventions, were informed orally
and in writing (upon willingness to participate) five most suitable teachers in each
school were involved in the study (see Table 3.4).

Table 3.4 Purposeful Sampling Criteria for Selecting Teachers

No Teachers' Role Sampling Criteria
1. Teaching SRH topics Experience (2 years and above)
2. Class/Health teacher Leadership in school-based SRH interventions
3. School Guardian/Counsellor SRH knowledge/training

Source: Field Data (2024)

3.4.4.3 Documents. The selection of documents for review involved agreement

with teachers to hand over their school-based SRH intervention records and other
SRH teaching and learning documents during in-depth interviews (see Table 3.5).
Other important school-based SRH documents which were not available in schools
were reviewed online and some were printed copies.

Table 3.5 Documents Reviewed

S/n School-based SRH Documents Sampling Criterion
1. The NSHP guidelines Content related to the
2. The biology and civics syllabus (2005) implementation of school-
3. The 2023 secondary education curriculum based SRH intervention
4. School-based SRH intervention records strategies

Source: Field Data (2024)

 31

3.5 Data Collection Methods

Data collection methods involved in-depth interviews and documentary review. As

recommended by (Creswell & Poth, 2018; Yin, 2018) the use of in-depth interviews
and documentary review in a case study design emphasizes the importance of in-
depth exploration, contextual understanding, objective, and subjective understanding
of participants' experiences, and data triangulation even in a relatively small sample.

3.5.1 In-depth Interviews

The researcher conducted 25 in-depth interviews with secondary school teachers in

Dodoma City secondary schools, 5 with biology teachers, 5 with civics teachers, 5
with class teachers, 5 with health teachers, 4 with school guardians, and 1 with a
teacher-counsellor (see Table 4.2 in Section 4.1.2 for more details). Interview guides
utilised open-ended questions to maintain focus and encourage participants' freedom
to share their thoughts and experiences (see Appendix D). Interview sessions took
place in private spaces during or immediately after school hours and lasted between
30-60 minutes. A research journal and audio recorder were used to take field data.
Data collection involved English and Swahili language; the researcher being
proficient in both languages translated the Swahili language data with the assistance
of Microsoft Translator while utilising reflexivity and member checking techniques
to ensure trustworthiness of the study.

3.5.2 Documentary Review

Various institutional documents were reviewed including school-based SRH policies

and guidelines, SRH teaching and learning documents, school-based SRH
implementation records, and other relevant documents utilised by teachers to
implement SRH intervention strategies in Dodoma City secondary schools.

3.6 Data Analysis Strategy

Data analysis strategy employed Braun and Clarke (2006) six stages of thematic
analysis. The first stage involved familiarisation with data content through intensive
reading and transcription. The second stage involved generating initial codes by
grouping and organizing data sets in accordance to the research objectives. The third
 32

stage was to search for the themes by checking data relevance in relation to each
research objective and question. The fourth stage was to review themes to crosscheck
data accuracy based on each research objective. The fifth stage involved defining and
naming each theme with a detailed analysis per objective. The final stage was to
write the research report by weaving together data extracts and providing
contextualisation based on existing literature (see Table 3.6).

Table 3.6 Six Stages of Thematic Analysis

Stages
1. Familiarisation with data content
2. Generating initial codes
3. Searching for themes
4. Reviewing themes
5. Defining and naming themes
6. Writing the report
Actions
 Intensive reading and transcription
 Organising and grouping data sets
 Checking data relevance
 Checking data accuracy
 Detailed analysis of each theme
 Presentation and contextualisation

Source: Braun and Clarke (2006) and Field data (2024)

3.7 Trustworthiness of the Study

Trustworthiness or rigour of the study refers to the degree of confidence in the

accuracy and quality of the study findings, methods, and interpretation employed. In
qualitative research rigour of the study can be established through credibility,
transferability, dependability, and confirmability (Anney, 2014).

3.7.1 Credibility

Credibility refers to the extent to which the findings and interpretations accurately
represent the experiences and perspectives of the participants (Lincoln & Guba,
1985). Credibility was maintained through purposive sampling and in-depth
interviews of participants with SRH knowledge and diverse experience in
implementing school-based SRH intervention strategies, and documentary review.

3.7.2 Confirmability

Confirmability refers to the objectivity and neutrality of the research findings

grounded in the data rather than biased by the researcher’s perspectives or
preconceived notions (Tobin & Begley, 2004). Through reflexive diary, multiple
 33

sources of data, and member checking the researcher reflected on his own biases
throughout the research process.

3.7.3 Dependability

Dependability refers to the consistency and stability of findings over time (Yin,
2018). To establish dependability stepwise replication, audit trail, and peer
examination were used to crosscheck the data collection and analysis process to
ensure findings are consistent and accurate.

3.7.4 Transferability

Transferability refers to what extent the study findings can be applied to other
research contexts (Tobin & Begley, 2004). To enhance transferability the researcher
has provided a rich description of the research problem, methods, participants, and
the study area.

3.8 Ethical Considerations

The researcher has considered the following ethical issues:

3.8.1 Institutional Research Review, Approval, and Clearance

The study followed the University of Dar es Salaam institutional research review,
approval, and clearance procedures (see Appendix J).

3.8.2 Study Area Research Permits

The researcher obtained research permits from the Dodoma City director and the
head of the secondary school division in Dodoma City (see Appendix K).

3.8.3 Informed Consent

Before conducting any data collection all participants and schools were informed
orally and in writings about the purpose of this study. This included the procedures
involved, potential benefits, risks, and participants' rights to voluntary participation
and withdrawal at any time (see Appendix C).
 34

3.8.4 Confidentiality

Confidentiality is strictly observed, the pseudonyms and code numbers have been
utilised to protect schools and participants' privacy and identities, while black shades
on document pictures have been used to hide sensitive data, school names, and
participant identities (see Table 4.2 in Section 4.1.2).

3.8.5 Safety

In all stages, the study has protected participants' rights and dignity from harm and
distress related to the study.

3.8.6 Researcher-Participant Relationships

Professionally the researcher is a teacher-counsellor; his professional experience

assisted him to maintain a good relationship with the study participants and to reduce
biases while increasing trust and enhancing participants' self-disclosure.

3.8.7 Respect for Cultural Differences

The study ensured respect for cultural differences during and after data collection by
avoiding violation of school norms or practices. This involved working closely with
the school management to ensure the study is culturally appropriate and respectful.

3.8.8 Data Security and Management

Data security and management was observed by complying with relevant data
protection laws and regulations, preventing unauthorised access to data by handling,
storing, analysing, and reporting findings responsibly.

3.9 Chapter Three Summary

Chapter three has presented the research methodology, highlighting the research
approach and design, sampling, data collection methods, data analysis strategy,
trustworthiness of the study, and ethical considerations.
 35

CHAPTER FOUR
DATA PRESENTATION, ANALYSIS, AND DISCUSSION OF THE STUDY
FINDINGS
4. Introduction

This chapter highlights the presentation, analysis, and the discussion of the study
findings. The problem addressed by this study is the inadequate implementation of
school-based SRH intervention strategies for adolescents. The purpose of this study
was to explore the role of teachers in fostering the implementation of school-based
SRH intervention strategies for adolescents in Dodoma City secondary schools. The
study had three objectives with a specific focus on the perceived role, strategies, and
barriers facing teachers in the implementation process. Guided by the ecological
systems theory and informed by existing literature, the researcher employed a
qualitative research approach in a single case study design to explore the research
problem in its naturally occurring context. Five schools and twenty-five teachers
were purposively involved in the study. Data collection utilised in-depth interviews
and documentary review, while data analysis utilised thematic analysis strategies.

4.1 Demographic Information of the Study Participants

The study involved twenty-five participants from five secondary schools in Dodoma
City. Comprising fourteen female and eleven male teachers who were actively
involved in implementing school-based SRH intervention strategies with diverse
work environment, experience, education levels, SRH training, leadership, and
gender (see Table 4.1- 4.2 in Section 4.1.1- 4.1.2 for more information).

4.1.1 Schools' Demographic Information

Table 4.1 Schools' Demographic Information
School Type Number of Number of Trained Pregnancy Active SRH
adolescents teachers Teachers Cases Programmes
SS1 Public 1369 80 3 4 2
SS2 Private 706 32 2 0 3
SS3 Public 1117 58 1 3 1
SS4 Private 610 27 2 2 2
SS5 Public 1305 38 0 6 3
Total 5 5107 235 8 15 11

Source: Field Data (2024)

 36

4.1.2 Teachers' Demographic Information

Table 4.2 Teachers' Demographic Information
School Teacher Sex Education Work Involvement in S-B Size
Code Code Level Experience SRH-Interventions
A F Degree 13 years Teaching civics
B F Degree 4 years Teaching biology
SS1 C M Degree 17 years School guardian 5
D F Degree 10 years Health teacher
E M Diploma 9 years Class teacher
F F Degree 8 years Teaching civics
G M Degree 5 years Teaching biology
SS2 H M Diploma 6 years School guardian 5
I F Masters 17 years Health teacher
J M Degree 11 years Class teacher
K M Degree 6 years Teaching civics
L F Degree 3 years Teaching biology
SS3 M F Degree 10 years Teacher-counsellor 5
N M Degree 13 years Health teacher
O F Masters 18 years Class teacher
P F Degree 5 years Teaching civics
Q M Diploma 8 years Teaching biology
SS4 R F Degree 4 years School guardian 5
S M Degree 10 years Health teacher
T F Degree 12 years Class teacher
U M Degree 5 years Teaching Civics
V M Masters 20 years Teaching biology
SS5 W F Degree 7 years School guardian 5
X F Degree 12 years Health teacher
Y M Degree 4 years Class teacher

5 Total 25

Source: Field Data (2024)

4.2 Data Presentation, Analysis, and Discussion of the Study Findings

This section presents the data analysis and discussion of the study findings on the
role of teachers in fostering the implementation of school-based SRH intervention
strategies for adolescents in Dodoma City secondary schools. The data analysis and
the discussion of findings are presented in relation to each research objective,
research question, existing literature highlighted in this study, the research problem,
and the theory underpinning this study. Each section starts with the data presentation
and analysis of the study findings followed by the discussion.
 37

4.2.1 The Perceived Role of Teachers in Fostering the Implementation of

School-based SRH Intervention Strategies for Adolescents in Dodoma City
Secondary Schools

The first research objective aimed to explore the perceived role of teachers in
fostering the implementation of school-based sexual and reproductive health
intervention strategies for adolescents. The intention was to check if teachers
understand/interpret their role as highlighted in the existing literature, school-based
SRH policies, and strategies. The study findings revealed that teachers in Dodoma
City secondary schools view themselves as designers and implementers of school-
based SRH intervention programmes, reliable formal sources of SRH knowledge,
and coordinators of school-community collaboration and partnerships as well as
advocates and referral systems concerning SRH issues among adolescents in schools.
All twenty-five participants were involved in qualitative data collection through in-
depth interviews and triangulated by documentary review. Data were analysed
thematically as presented below.

4.2.1.1 Role of Designing and Implementing School-based SRH Intervention

Programmes. The study findings revealed that teachers in Dodoma City secondary
schools view themselves as designers and implementers of school-based SRH
intervention programmes including both behavioural and structural interventions. As
expressed by a teacher from SS1;
The scheme of work and the lesson plan are the key. We start by
designing the teaching and learning activities, organising the
resources, and engaging students. To arrange for SRH study tours,
parental meetings, or inviting guest speakers needs proper planning
and implementation (Interview, Teacher A, SS1, 18/1/2024).

On the other hand, teachers' lesson plans also indicated the creative role of teachers
in designing and implementing SRH lessons. As the following part of SS3 lesson
plan indicates;
 38

Picture 4.1 SS3 Civics Lesson Plan

Source: Field Data (2024)

The study findings further revealed that teachers' perceived role in designing and
implementing school-based SRH interventions is beyond curriculum interpretations.
Teachers perceived role involve the execution of other national school-based SRH
intervention strategies and policy guidelines in schools. As expressed by a teacher
from SS2;
Apart from the curriculum, we are also responsible for implementing
other policies such as policy guidelines for implementing
HIV/AIDS/STDs in schools (Interview, Teacher F, SS2, 19/1/2024).

Similarly, documentary review findings also revealed that teachers design and
implement projects that aim to reduce the impact of adolescents' vulnerability to
negative sexual and reproductive health outcomes as a part of SS5 dormitory
construction project indicates;

Picture 4.2 SS5 Dormitory Construction Project

Source: Field Data (2024)

The study further indicated that the perceived role of teachers in designing and
implementing school-based SRH interventions enhances collective efforts between
teachers, adolescents, school management teams, adolescent families, and
communities against the negative SRH outcomes. A teacher from SS2 shared;
 39

We design and implement SRH programmes in collaboration with the

school management team, peer educators, parents, and other related
stakeholders (Interview, Teacher I, SS2, 22/1/2024).

Similarly, a teacher from SS4 expressed;

We always engage other key stakeholders. However, other
interventions need more arrangements of time, funds, and security
(Interview, Teacher S, SS4, 24/1/2024).

The study findings indicate that teachers’ interpretations of their role align with the
actual role highlighted in policies and strategies that guide the implementation of
school-based SRH intervention strategies. Their self-determination, understanding,
and motivation indicate their learning from experience in teaching comprehensive
sexuality education, parental and community involvement, as well as guidance and
counselling services. The study participants indicate that teachers in secondary
schools can foster adequate implementation of school-based SRH intervention
strategies from the micro to the macro level systems. This aligns with Chavula et al.
(2021) who similarly found that the commitment and preparedness of teachers in
designing and implementing school-based SRH intervention strategies such as CSE
and LSE determines positive SRH outcomes among adolescents in schools.

Moreover, teachers' positive perceived role in designing and implementing school-

based SRH intervention programmes indicates a cost-effective implementation
strategy. Training and utilizing more teachers in designing and implementing school-
based SRH intervention strategies can minimize the cost of SRH interventions in
schools and adolescent communities. This underscores UNICEF (2021b) emphasis
on cost-effective interventions in reducing HIV/AIDS prevention and care among
adolescents. Teachers work in a structured system that can reach a substantial
number of adolescents, parents, community members, government officials, and
other related stakeholders who can mobilize resources to achieve shared
responsibility, support, and security for in-school adolescents and their communities.

The study findings further indicate that teachers' perceived role in designing and
implementing school-based SRH intervention strategies can lead to large-scale
implementation of SRH interventions among adolescents. This aligns with the
 40

UNAIDS (2022) global AIDS report urgent need for countries to elevate financial
and political prioritisation of HIV prevention by shifting from fragmented
intervention projects to large-scale implementation programmes. Emphasising the
role of teachers in fostering school-based SRH intervention strategies can increase
teachers' potential and capacity to design and implement school-based SRH
intervention programmes in relation to existing global and national policies that
embrace a multifaceted approach to adolescents' ecological systems.

Moreover, according to PORALG (2020) Tanzania Basic Education Statistics,

Dodoma City holds 56 secondary schools with more than 1724 teachers and 30757
adolescents. These teachers if well trained and resourced hold the potential to play a
significant role in fostering the implementation of school-based SRH intervention
strategies for adolescents. However, contrary to the Tanzania national school health
policy guidelines, the Tanzania health sector strategic plan V (2021-2026) has put
much emphasis on out-of-school adolescents. This indicates the underutilisation of
the potential role of teachers and the school environment in implementing SRH
intervention strategies for adolescents. As a result, adolescents in schools continue to
suffer from negative SRH outcomes such as early pregnancies and HIV infections.

4.2.1.2 Role of Being the Reliable Formal Sources of SRH Knowledge in

Schools. The study findings revealed that teachers interpret their role as reliable
formal sources of SRH knowledge and information among adolescents in Dodoma
City secondary schools. Teachers consider themselves as the authorities that students
trust and contact first in handling their SRH issues in schools. This awareness
indicates their potential to address the negative SRH outcomes among in-school
adolescents. The perceived role also enhances the capacity of teachers to learn more
about adolescents' SRH issues and needs. As accounted by a teacher from SS3;
In many cases, adolescents believe teachers have super wisdom. They
trust and think we know everything about SRH. To reach their
expectations we have to possess a comprehensive knowledge about
SRH (Interview, Teacher B, SS1, 18/1/2024).

Similarly, a teacher from SS1 Conveyed;

 41

Adolescents need SRH knowledge more than we can imagine, some of

their SRH concerns are very sensitive and need adequate knowledge
and time to respond (Interview, Teacher K, SS3, 22/1/2024).

Teachers' responses indicate the need for SRH knowledge among in-school
adolescents. Elaborating on their experience in executing the perceived role as
sources of knowledge through teaching comprehensive sexuality education topics,
teachers assist in-school adolescents in maintaining positive lifestyles, behaviours,
and attitudes about SRH issues. As articulated by a teacher from SS2;
These days, teenagers become sexually active very early; to reduce
the rate of early pregnancies, STIs, and HIV infections they need
appropriate comprehensive sexuality education (Interview, Teacher J,
SS2, 22/1/2024).

Similarly, a teacher from SS5 elaborated;

We create and implement CSE programmes that encourage students
to interact. We use group discussions to enhance group sharing and
understanding, individual sessions, and peer education to encourage
free and open sharing (Interview, Teacher U, SS5, 25/1/2024).

In addition, documentary review findings indicated the ability of teachers to enhance

SRH knowledge acquisition among in-school adolescents as the following part of a
lesson plan indicates;
Picture 4.3 SS1 Biology Lesson Plan

Source: Field Data (2024)

The perceived role of teachers as reliable formal sources of SRH knowledge among
adolescents in Dodoma City secondary schools indicates the capacity of teachers to
assist in-school adolescents to acquire adequate SRH knowledge. In addition,
teachers' experience has revealed that SRH knowledge is highly needed among
 42

adolescents in schools. This indicates that adequate utilisation of the role of teachers
in fostering school-based SRH knowledge intervention strategies will enhance
adequate SRH knowledge acquisition among adolescents in schools. The study
findings are inconsistent with a study by Keogh et al. (2020) on classroom
implementation of national sexuality education curricula in low-and middle-income
countries, which revealed that students in secondary schools have a great desire to
cover SRH topics due to insufficient SRH knowledge among teachers.

However, contrary to Keogh et al. (2020) teachers in this study despite a lack of
adequate SRH training have been motivated by the perceived role of being the
reliable formal sources of SRH knowledge among adolescents in schools, to learn
more about SRH issues and needs among in-school adolescents. In addition, the
study findings have revealed that teachers in this study maintain innovative teaching
methods that encourage interaction activities necessary to assist in-school
adolescents to acquire and develop effective SRH knowledge, skills, and values.
However, the study findings have revealed that teachers translate complex SRH
information and services among adolescents. They should be skilled in effective
communication strategies to convey SRH messages and interventions in a clear
culturally sensitive and age-appropriate manner.

Furthermore, findings from documentary review revealed that teachers in Dodoma

City secondary schools lack formal school-based SRH policies that prioritise their
role beyond the curriculum-based role. Consequently, the implementation of school-
based SRH knowledge intervention strategies for in-school adolescents in Dodoma
City secondary schools remains inadequate. This is consistent with a study by
Millanzi et al. (2022) on the effect of integrated SRH lesson materials in Dodoma
and Lindi regions of Tanzania that found existing SRH guidelines and materials
seem to lack a formal pedagogical and structural guide to help teachers in facilitating
SRH interventions for adolescents in schools.

Other studies have shown that the main causes of early pregnancies among
adolescents include low levels of SRH knowledge, sexual violence, and poverty
related transactional relationships (Nkata et al., 2019; Moshi & Tilisho, 2023; Obach
et al., 2019; WHO, 2022). Enhancing the commitment and capacity of teachers to
 43

foster the implementation of school-based SRH knowledge intervention strategies

will reduce negative SRH outcomes among in-school adolescents from the micro
system (individual school) to the macro system (national SRH public policy level).

4.2.1.3 Role of Enhancing School-Community Coordination, Collaboration,

and Partnership. The study findings revealed that teachers understand their role in
enhancing school-community coordination, collaboration, and partnership. Teachers
engage the community to bridge the gap between the school environment and the
broader adolescent communities by facilitating awareness creation programmes for
parents and participating in joint meetings with community members such as the
ward child and women protection committee. As shared by a teacher from SS2;
This is a community school, so we must engage and be engaged in
student communities. Some critical issues such as early pregnancies,
sexual violence, and child marriages mostly arise from adolescent
communities (Interview, Teacher H, SS2, 19/1/2024).

Similarly, a teacher from SS3 shared;

We plan and implement joint programmes that engage teachers,
parents, health workers, adolescents, and other related stakeholders.
We also form partnerships with parents, local government authorities,
NGOs, CBOs, and CSOs, (Interview, Teacher O, SS3, 23/1/2024).

The study also found teachers in Dodoma City assist adolescents to navigate the
process of getting services in complex systems and bureaucracies by collaborating
with community agencies such as the police gender desk, and other community
service providers such as community health workers and social welfare officers for
more specialised services. As a teacher from SS1 stated;
Some SRH issues among adolescents need medical attention, legal
actions, and psychosocial support. For more specialised assistance,
we engage other community service providers such as doctors, legal,
and police officers (Interview, Teacher E, SS1, 19/1/2024).

Similarly, a teacher from SS2 explained;

We have the ward education coordinator whose job is to ensure the
school and student communities work together in the overall school
development projects including SRH interventions (Interview, Teacher
G, SS2, 19/1/2024).
 44

On the other hand, findings from documentary review also indicated that teachers
play a crucial role in school-community coordination, collaboration, and partnership.
As shown on the following part of SS2 health strategic plan;

Picture 4.4 SS2 School Health Strategic Plan

Source: Field Data (2024)

The study findings indicate that teachers understand the importance of structured
collaboration with external stakeholders to create a holistic, inclusive, and more
integrated school-based SRH interventions in schools. Furthermore, the study
findings indicate that teachers play a significant role in engaging adolescents'
communities in organising common goals, joint efforts, strategic partnerships,
planning, and implementing school-based SRH interventions. The role of teachers
enhances shared responsibilities between teachers, adolescents, parents, and
community social groups. The study findings are consistent with UNESCO (2024)
which found that the role of teachers in fostering community participation has the
potential to improve the availability of YFHS, reduce HIV infections, early
pregnancies, and increase psychosocial support, educational achievement as well as
school completion rates among adolescents in secondary schools.

However, the study findings indicate that despite teachers' positive interpretation of
their role in fostering community participation in school-based SRH interventions,
the majority of teachers in Dodoma City secondary schools rely on informal
intervention structures that lack documentation, proper planning, organisation,
monitoring, and evaluation systems. As a result, the implementation of school-based
SRH intervention strategies in Dodoma City secondary schools remains inadequate.
The study findings correspond with Hakielimu (2021) study findings on SRH policy
and practice in primary and secondary schools in Tanzania mainland, which revealed
 45

that informal SRH intervention structures and a lack of documented evidence of SRH
interventions in Tanzania schools result to inadequate implementation of school-
based SRH intervention strategies for adolescents.

It is clearly shown that successful implementation of school-based SRH intervention

strategies at all levels depends on strong coordination, collaboration, and partnership
among teachers, community members, and other related stakeholders. Teachers have
the opportunity to engage adolescent communities in school-based SRH
interventions through their schools and students (adolescents). Teachers can
minimize enhance effective resource mobilisation and utilisation while reducing
intervention costs. Prioritising the role of teachers in priority setting, planning,
implementation, monitoring, and evaluation of school-based SRH interventions will
enhance adequate, well-coordinated, and formal structured interventions in schools.
Furthermore, this will create more health promoting schools where all members of
the school community will cooperate to promote and protect adolescents' sexual and
reproductive health.

4.2.1.4 Role of Advocacy and Referral. The study found that the perceived role of
teachers in Dodoma City secondary schools regarding the implementation of school-
based SRH interventions involve advocacy and referral. Teachers advocate for in-
school adolescents' SRH problems and act as referral systems. Addressing and
representing adolescents' SRH concerns and issues to the wider public. While referral
is not a sole component of advocacy, the study found it complements teachers'
advocacy efforts when ensuring in-school adolescents receive support and assistance
beyond advocacy messages. Teachers engage adolescents by referring them to
services, resources or support systems that align with the specific objectives of their
school-based SRH interventions. As a teacher from SS3 articulated;
Sexual abuse cases, HIV/AIDS, FGM, absenteeism, early
pregnancies, early marriages, and many other problems demand
public attention and joint efforts from the public and other service
providers (Interview, Teacher M, SS3, 23/1/2024).

Findings revealed that teachers play a role in advocacy for adolescents' problems in
schools by disseminating information to the public for comprehensive interventions
 46

and ecological systems changes. This underscores the ecological factors affecting
health from the individual level to the societal level. As a teacher from SS4
elaborated;
For the voiceless and the most vulnerable, we use outreach
programmes to advocate for more help and support from their
community social agencies (Interview, Teacher Q, SS4, 23/1/2024).

Findings further revealed that teachers' perceived role of advocacy involves

awareness in supporting adolescents to address barriers to SRH services and
resources in their schools and communities. As a teacher from SS3 elaborated;
Adolescents in schools suffer from several social issues connected to
SRH that need collective efforts. Poverty and social-cultural barriers
for example; need advocacy to influence public health policy actions
to help adolescents navigate school and community life positively
(Interview, Teacher L, SS3, 22/1/2024).

This perceived role indicates teachers' commitment to raise in-school adolescents'

voices to enhance more ecological systems support and solutions concerning issues
affecting adolescents' sexual and reproductive health and academic development. As
articulated by a teacher from SS1;
We use social networks, local government leaders, and religious
institutions to assist adolescents to get more public support and
security (Interview, Teacher C, SS1, 18/1/2024).

Similarly, a teacher from SS2 conveyed;

We report sexual violence incidences, vulnerability, pregnancy cases,
and other related issues (Interview, Teacher I, SS2, 22/1/2024).

The study found that teachers' role in advocacy and referral reduces adolescents'
vulnerability to negative sexual and reproductive health outcomes including social
and cultural barriers. It also increases school completion rates among in-school
adolescents especially girls. As revealed by a teacher from SS5;
I remember one case about a student who was to get married when
she was in form two. I shared the story with the district social welfare
officers. I am so grateful she was rescued from that situation and this
year she is expected to complete her studies (Interview, Teacher W,
SS5, 25/1/2024).
 47

The study findings indicate that teachers' advocacy messages enhance public
participation and ecological systems support in school-based SRH interventions.
Most significantly, teachers' advocacy role has the potential to increase school
completion rates among adolescents. The study findings are consistent with the
UNICEF (2021a), UNESCO (2024), and the Tanzania Ministry of Health (2022)
TDHS-MIS highlighted that each incremental year of education beyond primary
school generates health, social, and economic dividends. Completion of secondary
school among adolescents has a multiplier effect of health, social, and economic
benefits for in-school adolescents' families and their broader communities. These
benefits ultimately reduce in-school adolescents' vulnerability to HIV infections,
violence, child marriages, and teenage motherhood.

The study findings on the perceived role of teachers in advocacy and referral further
indicate that teachers can foster the implementation of school-based SRH
interventions at all levels of the ecological systems, from the microsystem
(home/school) to the macrosystem (larger forces shaping the implementation of SRH
intervention strategies in secondary schools). The study findings have further
indicated that teachers can assist adolescents to overcome high risk situations to their
adolescent health while empowering them to access resources that enable them to
progress. The study findings underscore Bronfenbrenner's (1979) ecological factors
affecting health from the individual level to the societal level. Teachers play a role in
influencing positive SRH changes at adolescent individual levels to the public health
policies that govern SRH intervention strategies in schools.

Furthermore, teachers perceived role in advocacy and referral indicates the capacity
of teachers to lead school-based health intervention programmes that assist in-school
adolescents to address systemic barriers in accessing sorely needed SRH services.
This under score a study by Chilambe (2023) and Obach et al. (2022) who similarly
revealed that teachers' role of advocacy and referral in addressing adolescents' sexual
and reproductive health problems, creates conducive and supportive environment for
adolescents to access adequate SRH information and services. The findings of this
study therefore, encourage teachers to integrate the ecological systems approach in
 48

designing and implementing school-based SRH interventions to accommodate

broader adolescent SRH needs.

4.2.2 Strategies utilised by Teachers to Implement School-based SRH

Interventions for Adolescents in Dodoma City Secondary Schools

The second research objective aimed to examine strategies utilised by teachers to

implement school-based sexual and reproductive health interventions for adolescents
in Dodoma City secondary schools. The intention was to explore how teachers
execute their role in implementing school-based SRH intervention strategies. The
study findings identified strategies such as comprehensive sexuality education,
parental and community involvement, guidance and counselling, as well as peer
education as common school-based SRH intervention strategies employed by
teachers to intervene SRH issues among adolescents in Dodoma City secondary
schools. All twenty-five participants were involved in qualitative data collection
through in-depth interviews and triangulated by documentary review. Data were
analysed thematically as presented below.

4.2.2.1 Comprehensive Sexuality Education (CSE) Strategy. Findings revealed

that comprehensive sexuality education is a primary SRH intervention strategy
employed by teachers in Dodoma City secondary schools through the teaching of
SRH topics in biology and civics (see Appendix F & G for more details). Teachers'
in-depth interviews revealed that even those who are not teaching biology and civics
indirectly play a significant role in providing comprehensive sexuality education to
adolescents in schools. As a teacher from SS2 expressed;
Teaching comprehensive sexuality education is our main SRH
intervention strategy. All teachers are involved in the implementation
process directly or indirectly (Interview, Teacher I, SS2, 22/1/2024).

Similarly, a teacher from SS5 elaborated;

Adolescents undergo several unprepared physical, emotional, and
social changes. For example, girls have knowledge gaps and
misconceptions about menstruation, especially the first menstrual
cycle. They end up in bleeding emergencies, menstrual cramps, fear,
and anxiety. CSE assist young girls to get prepared for good
menstrual hygiene (Interview, Teacher X, SS5, 26/1/2024).
 49

During in-depth interviews, teachers' explanations indicated that teaching

comprehensive sexuality education enhances SRH knowledge acquisition among
teachers and assists adolescents in schools to be self-aware about sexual and
reproductive health challenges. A teacher from SS4 explained;
Adolescence is an experimental age; some enter into sex relationships
just to confirm their beliefs about sex. They have many conflicting
messages. We encourage them to understand and master their
physical, cognitive, emotional, and behavioural challenges
(Interview, Teacher Q, SS4, 24/1/2024).

Similarly, a teacher from SS1 articulated;

Teaching SRH topics is a practical learning experience for teachers.
The more we teach, the more we learn about SRH issues among
adolescents (Interview, Teacher D, SS1, 18/1/2024).

The study findings further revealed that teachers engage students in learning about
SRH issues through individual sessions, group discussions, guest speaking
programmes, student health clubs, and debates to enhance collective understanding
and support among adolescents. As conveyed by a teacher from SS3;
SRH topics are very interesting and sensitive, we teach, guide, and
facilitate students group discussions, debates, subject clubs, and study
tours (Interview, Teacher N, SS3, 23/1/2024).

The study findings also revealed the existence of student subject clubs in Dodoma
City secondary schools that address student health care issues as indicated by Section
C of the constitution of SS2 student science club;

Picture 4.5 SS2 Student Science Club

Source: Field Data (2024)

Furthermore, teachers' scheme of works also indicated that teachers prepare for SRH
teaching in both long and short-term plans. As indicated by the following part of the
biology scheme of work prepared by a teacher from SS4;
 50

Picture 4.6 SS4 Biology Scheme of Work

Source: Field Data (2024

However, the review of the 2023 secondary education curriculum (form I-IV)
revealed that SRH topics in biology have been eliminated with exception of two
topics for form four classes; while civics is completely abolished (see Appendix H).
Teachers also conveyed the same message. As a teacher from SS4 stated;
The best curriculum changes must improve situations. I think they
have to review the 2023 biology curriculum and re-think the decision
to abolish civics (Interview, Teacher T, SS4, 24/1/2024).

In the same vein, a teacher from SS3 elaborated;

The abolition of civics means topics that address the social, cultural,
political, and economic issues related to SRH will not be taught in
secondary schools. You can imagine how in-school adolescents will
grow blindly (Interview, Teacher K, SS3, 22/1/2024).
 51

The study findings indicate that teachers play a significant role in implementing CSE
as a strategy to address the physical, cognitive, behavioural, emotional, and social
challenges that inhibit positive SRH outcomes among adolescents. Furthermore, the
study findings have shown that comprehensive sexuality education is the only formal
and effective school-based SRH intervention strategy that promotes positive SRH
behaviours and knowledge among adolescents, their families and communities.
Moreover, the study findings have revealed that through teaching CSE teachers learn
more about SRH issues among adolescents. This underscores the perceived role of
teachers of being the formal sources of SRH knowledge among adolescents in
schools. The study findings also align with UNESCO (2018) recognition of teachers'
central role in the implementation of CSE strategy in schools.

On the other hand, the study findings contradict Mboneko and Iramba (2022) study
findings on the lack of SRH training as a barrier towards implementing CSE in
Tanzania public secondary schools. This study has established that the lack of
specialised SRH training among teachers is not necessarily a barrier towards
implementing CSE in schools, because the positive perceived role of teachers of
being the reliable sources of SRH knowledge in schools and the practical experience
of teaching CSE motivate teachers to learn more about SRH issues among
adolescents. Consequently, the more teachers implement comprehensive sexuality
education, the more they become knowledgeable and experienced with SRH issues
among adolescents. However, unskilled teachers can negatively affect the delivery of
comprehensive sexuality education in schools (Kishaluli & Mollel, 2023).

Furthermore, the elimination of crucial SRH topics in biology and the abolition of
civics in the 2023 ordinary secondary education curriculum indicate a crisis for
adolescents to acquire formal SRH knowledge in schools. It also denies the crucial
role of teachers in fostering the implementation of school-based SRH intervention
strategies for adolescents in Tanzania secondary schools. This corresponds with a
study by Ngissa et al. (2024) which concluded that SRH education in Tanzania is not
comprehensive. Furthermore, the study findings establish that the undergoing
curriculum changes in Tanzania indicate a systematic shift from formal school-based
SRH intervention programmes implemented by teachers to initiatives implemented
 52

by non-school service providers and the private sector. This continuation of the
underutilisation of the role of teachers will perpetuate the negative SRH outcomes
among adolescents in schools.

Moreover, these remarkable changes contradict the Tanzania National School Health
Policy (2018-2023), the 2021-2025 Secondary Education Quality Improvement
Project (SEQUIP) commitments, the Eastern and Southern Africa (ESA) Inter-
ministerial commitments on SRH rights for young people and adolescents, as well as
the global efforts against the negative SRH outcomes among adolescents. These
changes can further impair school-based SRH policy priorities and implementation
efforts. Consequently, adolescents in Dodoma City secondary schools and other
similar contexts in Tanzania will continue to suffer from early pregnancies, HIV
infections, academic failures, school dropouts, poverty, and other consequences that
lower secondary education completion rates among in-school adolescents.

4.2.2.2 Guidance and Counselling Strategy. Guidance and counselling found to

be a common school-based SRH intervention strategy utilised by teachers to
implement school-based SRH interventions in Dodoma City secondary schools. The
study found school guidance and counselling services include contraception
counselling, relationship counselling, and community counselling. However, the
majority of teachers interviewed in this study, use sub-standard guidance and
counselling services as a strategy to handle students' SRH issues. As explained by the
following teacher from SS4;
Guidance and counselling is a crucial part of our daily SRH
interventions. We assist in school adolescents to handle their
menstrual hygiene, relationship issues, stress, and social cultural
barriers. However, it requires specialised skills, knowledge, time, and
attention (Interview, Teacher S, SS4, 24/1/2024).

Similarly, a teacher from SS5 shared;

Teenage social life is full of drama, without proper guidance and
counselling services teenagers become sexually active early, leading
to early pregnancies (Interview, Teacher V, SS5, 25/1/2024).
 53

The study findings also revealed that in some teachers dedicate their resting time and
resources to undertake personal initiatives to reach out vulnerable adolescents in their
home and community places. As a teacher from SS4 expressed;
The most vulnerable are from dysfunctional families and
disadvantaged communities. We have outreach programmes during
weekends and holidays to learn more about their challenges and look
for the better solutions (Interview, Teacher P, SS4, 23/1/2024).

The study findings further revealed that there is no formal guidance and counselling
services in Dodoma City secondary schools. As a result, very few teachers dedicate
their time and attention to offer effective and adequate guidance and counselling
services for adolescents. However, despite practical and professional barriers
regarding guidance and counselling services in Dodoma City secondary schools,
SRH problems among in-school adolescents motivate teachers to offer informal
guidance and counselling services. As a teacher from SS2 shared;
I guide and counsel students albeit habitually, but it is very helpful.
There are times I make mistakes due to a lack of deeper technical
understanding, but the intention is to help than to leave them
struggling (Interview, Teacher G, SS2, 19/1/2024).

Similarly, a teacher from SS3 stated;

In our school we do not have a specific timetable for guidance and
counselling services, very few intake interviews end safely and the
waitlist is so long. To attend individual cases in one term is
impossible (Interview, Teacher M, SS3, 23/1/2024).

The study found that professional teacher-counsellors are very few in Dodoma City
secondary schools. In the five schools that participated in this research only one
school had one professional teacher-counsellor and another school had one teacher
specialised in educational psychology. The study further revealed that the very few
available teacher-counsellors are not recruited in schools to offer formal guidance
and counselling as independent services in schools. School counsellors are regarded
as common subject teachers while underutilised due to a lack of formal structured
counselling services in schools. A teacher counsellor from SS3 articulated;
 54

There is no formal structured guidance and counselling services in

our school. I work like other subject teachers, guidance and
counselling is a personal initiative I struggle to fulfil with my own
timetable. It needs extra time and commitment to handle student cases
under the tree or waiting after class hours. Sometimes it ends up in
ethical dilemma (Interview, Teacher M, SS3, 23/1/2024).

On the other hand, documentary review revealed that the procedure to obtain school
guardians/counsellors does not allow professionalism even in schools where
professional counsellors can play a role in fostering school-based SRH counselling
services. The majority of schools that participated in this study rely on the Ministry
of Education and Culture [MoEC], 2002) guidelines for implementing
HIV/AIDS/STDs and life skills education in schools and teachers' colleges. For one
to be a school Guardian/counsellor one has to maintain a good relationship with
students. The selection is neither based on training nor professionalism. As the
following part of the guideline indicates;

Picture 4.7 Guidelines for Selecting School Guardians/Counsellors

Source: MoEC (2002) and Field Data (2024)

The study findings indicate that teachers play a significant role in fostering the
implementation of guidance and counselling services as strategy to intervene against
negative SRH outcomes among adolescents in Dodoma City secondary schools. The
nature of teachers' school-based guidance and counselling services found to be
remedial, preventive, and curative to enable adolescents to live healthy while
achieving their academic goals and eventually become productive adults. The study
findings underscore the ecological factors affecting health from the individual to the
societal level. The study findings are consistent with a study by Kazimoto (2022)
 55

who found that guidance and counselling services in schools help adolescents to live
a fulfilled life.

However, the informal structure, unfriendly environments in schools, and a lack of

technical skills and counselling knowledge gaps among teachers lead to sub-standard
guidance and counselling services for in-school adolescents in Dodoma City
secondary schools. This underscores a study by Mchuchury and Gwajekera (2023)
who found that failure to establish formal school guidance and counselling services
in schools has led to unclear defined role of teacher-counsellors in schools. As a
result, the implementation of guidance and counselling services in schools remains
inadequate and ineffective. The findings of this study establish the need for effective
formal guidance and counselling services in Dodoma City secondary schools to
enable teachers to deliver their full potential in school-based guidance and
counselling interventions.

Furthermore, the study findings highlights the need for school-based guidance and
counselling interventions to have a multifaceted approach to change the
environmental conditions that negatively impact the lives of adolescents in schools.
Some adolescents are victims of poverty, sexual violence, early pregnancies, and
HIV infections. In the face of these realities school guidance and counselling services
need to promote positive changes in the social systems that affect the well-being of
adolescents in schools from the micro individual clients to the macro social groups.
The study findings have indicated that if well trained and utilised teacher-counsellors
can initiate preventive SRH guidance and counselling programmes and services that
positively impact in-school adolescents in their ecological systems. This correspond
with Lewis et al. (2011) community counselling approach which highlighted that
human behaviour is powerfully affected by context, community counsellors should
use strategies that facilitate the healthy development both of their clients and of the
communities that nourish them.
 56

4.2.2.3 Parental and Community Involvement (PCI) Strategy. The study found
that teachers in Dodoma City secondary schools apply parental and community
involvement strategy in school-based sexual and reproductive health interventions.
Teachers involve parents and community members in SRH discussions and
awareness creation programmes. This underscores the perceived role of teachers in
enhancing school-community coordination, collaboration, and partnership. As a
teacher from SS3 elaborated;
The success of one adolescent means a lot to parents and
communities. Parents and community members are the first teachers
of our social norms, values, and beliefs. It is very important to share
our experiences with them (Interview, Teacher O, SS3, 23/1/2024).

Similarly, a teacher from SS5 stated;

We have the UWAWA [Ushirikiano wa Walimu na Wazazi] meaning
[Parents and Teachers Collaboration] programme. It sensitizes
parents' and teachers' commitment to share goals and make joint
efforts to foster the overall development of in-school adolescents
including SRH interventions (Interview, Teacher X, SS5, 26/1/2024).

Teachers revealed that parental and community involvement assists in addressing

sexual and reproductive health crosscutting issues that impair adolescents'
developmental progress. As explained by a teacher from SS2;
We involve parents and community members in discussing issues like
adolescent care and upbringing, safety, sexual violence among
adolescents, parent-child relationships, and conflict resolutions
(Interview, Teacher F, SS2, 19/1/2024).

Documentary review data also align with teachers' responses as shown in SS5
dormitory construction project;

Picture 4.8 SS5 Dormitory Construction Project Activities

Source: Field Data (2024)

Similarly, a teacher from SS2 articulated;

 57

Globalisation has changed everything. Parenting styles have

changed; parents are too busy to find money than taking care of their
children. The informal education institutions are no longer
functioning. To restore and rescue the situation we educate parents
too (Interview, Teacher H, SS2, 19/1/2024).

The study found that teachers in Dodoma City secondary schools involve parents and
community members to handle the overall school development programmes
including SRH issues. However, discussions on SRH interventions seem to be very
rare as explained by a teacher from SS1;
Parents and community members often attend school meeting sessions
during the beginning and the end of terms to discuss the overall
school academic progress. Specific agendas for SRH interventions are
very rare (Interview, Teacher W, SS5, 25/1/2024).

In addition, evidence from minutes of teacher-parent meetings indicated the

involvement of parents and community members in the overall school development
programmes. However, the study did not find specific documents that indicated a
specific agenda for school-based SRH interventions. As indicated below;

Picture 4.9 SS1 Teachers and Parents Meeting

Translated version;
MKONZE SECONDARY SCHOOL
MINUTES OF TEACHERS AND PARENTS MEETING
HELD ON 15TH /07/2023
SESSION AGENDA
1. OPENING
2. STUDENTS PROGRESS REPORT (FIRST TERM)
3. REPORT ON THE IMPLEMENTATION OF THE
RESPONSIBILITIES OF PARENTS COMMITTEES
4. MISCELLANEOUS
5. CLOSURE

Source: Field Data (2024)

 58

The study findings further revealed, in most cases teachers, parents, and community
members are the powerful forces that support or inhibit SRH interventions in
Dodoma City secondary schools. As a teacher from SS5 explained;
Most sexual violence cases among adolescents involve family and
community members. In addition, rare cases involve teachers. To find
effective solutions we engage parents and community members in the
intervention process (Interview, Teacher U, SS5, 25/1/2024).

In-depth interviews with teachers further revealed that parental and community
involvement in school-based SRH interventions make a difference in adolescent
families and communities. As a teacher from SS2 expressed;
I remember one case; a student told me she would rather live with
HIV/AIDS than living with her cruel and irresponsible father. I
planned a meeting with her father then we solved the problem in a
single session. She is now very happy and her father is very
cooperative (Interview, Teacher J, SS2, 22/1/2024).

The study findings indicate that the overall parental and community involvement in
schools depends on the role of teachers in facilitating school-community
coordination, collaboration, and partnership. Findings further revealed that if
teachers fail to act, parents and adolescents' communities fail to respond effectively
and to accommodate SRH challenges facing adolescents in schools. This underscores
a study by Walker et al. (2020) and IFMSA (2022) who similarly found that parental
and community involvement depends on the role of teachers in facilitating school-
community policy and decision making strategies. Since parents and community
members play a vital role in the formation of each subsequent generation, an
informed adult population appears to be a prerequisite to the attainment of a healthy
and educated society in which every adolescent will achieve their full potential.

The study findings have revealed that parents and community members have the
same goals for their children as teachers. They want their children to be as free as
possible from the negative SRH outcomes and to live a useful educated and
rewarding life. However, the study findings have revealed that these goals cannot be
reached without proper utilisation of the role of teachers in enhancing parental and
community involvement. The study findings are consistent with MoHCDGEC &
 59

MoEST (2018) and MoHCDGEC (2021b) which highlighted that teachers have a
responsibility to enhance parental and community participation in school-based SRH
interventions, however, parents and community members have not been as
responsive as they should be because of ineffective policy coordination and
implementation structure.

The study findings further indicate that through fostering parental and community
involvement in school-based SRH interventions, teachers influence positive changes
in adolescents' ecological systems by addressing family and community barriers
while increasing social support and security among adolescents. The role of teachers
in parental and community involvement also address the social and cultural barriers
facing adolescents from the micro to the macrosystem levels. The study findings are
consistent with Rizvi et al. (2020) and Abraha (2022) who similarly found SRH
intervention programmes that include an ecological and participatory approach are
more effective. Thus, the focus of school-based SRH intervention programmes
should expand systematically from the micro to the macro system levels.

4.2.2.4 Peer Education Strategy. The study findings identified peer education as
another prevalent school-based SRH intervention strategy utilised by teachers in
Dodoma City secondary schools. Teachers facilitate peer-to-peer SRH learning
programmes through student SRH clubs, group discussions, seminars, sports, and
games. This approach leverages the influence of peers to disseminate accurate SRH
information among adolescents and foster supportive student groups within schools.
As a teacher from SS3 expressed;
Peer educators function in a role similar to that of teachers, yet under
close supervision of class teachers, school guardian/counsellor, and a
health teacher. They become adept at various helping skills, methods,
and techniques while gaining confidence and the ability to evaluate
and test ideas and ultimately learn their strengths and limitations as
potential change makers (Interview, Teacher L, SS3, 22/1/2024).

Similarly, a teacher from SS4 expressed;

The extent of adolescents' involvement in sexual activities is
disturbing. It is the leading cause of academic discomfort among
teenagers in our school. To understand better their SRH issues we use
peer education programmes (Interview, Teacher R, SS4, 24/1/2024).
 60

The study also found that teachers in Dodoma City secondary schools use peer
education to counteract communication barriers between teachers and adolescents. It
also assists adolescents in exercising the power of self-care as explained by a teacher
from SS1;
Adolescents go through many hidden challenges. Some of them feel
shy or lack the confidence to share and speak openly to their teachers,
guardians or parents. To uncover their hidden stories, we use peer
education programmes (Interview, Teacher C, SS1, 18/1/2024).

Similarly, a teacher from SS5 shared;

Some students feel shy and lack confidence to talk openly about SRH
issues to their teachers and parents. Such students feel more
comfortable to talk to their peers. To fit the reality, we use peer
education programmes (Interview, Teacher Y, SS5, 26/1/2024).

The study also found that teachers use peer education to empower adolescents to be
decision makers, problem solvers, and active participants in fostering school-based
SRH interventions. A teacher from SS4 articulated;
Peer education programmes assist adolescents to understand their
feelings, learn effective communication and problem solving skills,
and resist peer pressure. We also empower them to share their hopes
and challenges (Interview, Teacher T, SS4, 24/1/2024).

The study further revealed that peer education programmes assist teachers to reach
more adolescents in their ecological systems. As elaborated by a teacher from SS1;
We group peer educators according to their community places and
give them self-care assignments in and out of school. Our main job is
to guide, monitor, and evaluate their peer groups and activities
(Interview, Teacher D, SS1, 18/1/2024).

On the other hand, the study findings revealed that teachers do not document peer
education programmes. In all five schools under this study, there were no records for
peer education programmes except a teaching resource for peer educators training
provided by a teacher-counsellor in SS3 as it is shown below;
 61

Picture 4.10 SS3 Peer Education Counselling Programme

Source: Field Data (2024)

The study findings indicate that teachers in Dodoma City secondary schools use peer
education strategy to address sexual and reproductive health issues among
adolescents. Peer education assists teachers to address SRH communication barriers
between teachers and adolescents, reduce intervention costs, and empower
adolescents to participate effectively in enhancing school-based SRH interventions in
schools. This underscores a study by Dodd et al. (2022) who found that peer
education enhances adolescents' self-awareness, self-care, self-efficacy, self-
empowerment, and confidence to handle their SRH issues. Similarly, the study
findings underscore Kyendikwa and Wong (2023) peer educator reference guide
which indicated that peer education enhances self-decision making and problem-
solving skills among adolescents concerning their SRH issues.

However, in-depth interviews along with documentary review indicate weak peer
education programmes in Dodoma City secondary schools. The lack of adequate peer
education programmes in schools may result to weak peer support groups and SRH
clubs among in-school adolescents. Teachers admitted to have competing priorities
while not having an official record keeping system for the few peer education
intervention programmes they undertake in schools due to informal implementation
structures. This indicates that the role of teachers in facilitating school-based peer
education programmes is underutilised. The study findings are consistence with
Akuiyibo et al. (2021) which highlighted that there is a need to engage teachers
 62

effectively in school-based peer education programmes to enhance more adolescent

involvement in solving their sexual and reproductive health problems.

The study findings have revealed that schools are controlled settings that are best for
the implementation of any SRH intervention strategy targeting adolescents. The
study findings further reveals that the best school-based SRH peer education
intervention programmes shall endeavour to support and promote active partnership
and participation of teachers, adolescents, parents, community members, and other
related stakeholders in programme design, implementation, monitoring, and
evaluation. Therefore, prioritising the role of teachers in facilitating school-based
SRH peer education intervention programmes will embrace actions directed towards
empowering more adolescents to acquire self-care skills, altruism for helping others,
and capabilities to fight against systemic barriers and the negative SRH outcomes.

4.2.3 Barriers Facing Teachers in the Implementation of School-based SRH

Intervention Strategies for Adolescents in Dodoma City Secondary Schools

The third research objective aimed to investigate barriers facing teachers in the
implementation of school-based sexual and reproductive health intervention
strategies for adolescents in Dodoma City secondary schools. The intention was to
explore the broader and large-scale obstacles facing teachers in the implementation
of school-based SRH intervention strategies. The study findings identified
inadequate policy interpretations, limited resources, limited access to sexual and
reproductive health services, and unfriendly school environments as barriers facing
teachers in Dodoma City secondary schools. All twenty-five participants were
involved in qualitative data collection through in-depth interviews and documentary
review. Data were analysed thematically as presented below.

4.2.3.1 Inadequate Interpretations of School-based SRH Policies. The study

findings revealed that policies are not well understood among teachers and
stakeholders, leading to incorrect or incomplete assessments of their meaning and
implications. For example, the national school health programme is too fragmented
from the national level to the school and community level. There is no clear flow of
resources and information as well as clear policy commitments that hold responsible
 63

decision makers accountable in schools except teachers (see Appendix I). As a result,
misapplications, failure to focus, and adhere to intended guidelines laid out in
policies or inconsistent implementation. On the other hand, the majority of teachers
interviewed in this study were not aware of the Tanzania national school health
programme strategic coordination. As articulated by a teacher from SS3;
To be honest I am not aware of the national school health policy
guidelines. What I know best is the curriculum and guidelines for
implementing HIV/AIDS/STDs and life skills education in schools
(Interview, Teacher N, SS3, 23/1/2024).

Similarly, a teacher from SS4 expressed;

I know there are policy guidelines on school health services in
Tanzania but I have no idea of what the document contains
(Interview, Teacher P, SS4, 23/1/2024).

The study findings also indicate that teachers' adherence to the national school health
policy and other adolescent health and development policies is inadequate. As a
result, the implementation of school-based SRH interventions remains inadequate
due to a lack of an informed decision-making system. A teacher from SS2 explained;
There is no special training concerning the implementation of
national policies or strategies. We depend much on what we know and
what can work best according to the nature of our problems and the
environment (Interview, Teacher G, SS2, 19/1/2024).

The implementation of school-based SRH intervention strategies in Tanzania

involves a multi sectoral approach between the Ministry of Education, Ministry of
Health, and the President’s office through regional and local government authorities.
However, apart from teachers' initiatives such as SRH guidance and counselling,
study tours, and the teaching of comprehensive sexuality education, teachers
declared to receive very few intervention programmes from health workers and local
government authorities. As a teacher from SS5 elaborated;
It is very rare to receive a self-committed intervention from the
Ministry of Health or regional administration and local governments,
unless it is a donor-funded project or a non-government sponsored
project. Their commitment and responses are very weak (Interview,
Teacher V, SS5, 25/1/2024).
 64

In-depth interviews with teachers further revealed that despite teachers' positive
perceived role and commitment in designing and implementing school-based SRH
interventions there is inadequate flow of information and decision-making systems
caused by inadequate policy interpretations among stakeholders. As the teacher from
SS3 explained;
Community health programmes rarely include school-based SRH
interventions until there is a very strong demand from the school
(Interview, Teacher A, SS1, 18/1/2024).

Furthermore, despite the national school health policy guidelines commitment on the
school health programmes as a part of community-based health programmes;
findings from teachers' in-depth interviews indicated that local government
authorities in village/street councils and ward development committees do not
include school-based SRH interventions in their community-based health
programmes. Consequently, school-based SRH interventions lack budgets, and
support from the Dodoma City Council and responsible ministries. This impairs
parental and community participation in school-based SRH intervention programmes
initiated by teachers. As elaborated by a teacher from SS4;
School-based SRH interventions are not well engaged in community
development health programmes. We are struggling to create
awareness among parents and community members through meetings
(Interview, Teacher Q, SS4, 24/1/2024).

The study findings indicate that inadequate interpretations of school-based SRH

policies result to weak coordination, collaboration, and partnership between teachers,
health workers, and local government authorities. As a result, the implementation of
school-based SRH intervention strategies for adolescents in Dodoma City secondary
schools remains inadequate. This aligns with the MoHCDGEC (2021b) which
highlighted that inadequate integration of adolescent interventions into
comprehensive council health plans result to inadequate implementation of health
intervention strategies in schools. Similarly, the MoHCDGEC and MoEST (2018)
indicated that before the 2018 national school health policy there was no clear
modality or structure for integrating activities, enhancing structured collaboration,
 65

and forging partnerships across inter-ministerial departments, agencies, and other key
stakeholders in school health initiatives.

However, despite policy reforms and guidelines, the study findings further indicate
there is no active regional, district, and ward school health task forces in Dodoma
City that actively involve teachers and adolescents regarding the implementation of
school-based SRH intervention strategies in Dodoma City secondary schools. The
study findings underscore the WHO (2019) report on the assessment of adolescent
health service barriers in the United Republic of Tanzania which revealed that poor
implementation of national health guidelines by health workers and local government
authorities. Other studies have shown that successful implementation of school-based
SRH intervention strategies depends on clear and adequate policy interpretations that
enhance strong coordination, collaboration, and partnership between stakeholders
(Abraha, 2022; Meherali et al., 2021; UNAIDS, 2023).

Furthermore, the study found that the undergoing educational policy changes
following the implementation and improvement of the 2014 Education and Training
Policy in Tanzania by (MoEST, 2023c) present a crisis in the implementation of
school-based SRH intervention strategies, specifically the underutilisation of the role
of teachers in fostering the implementation of school-based SRH intervention
strategies. The review of the 2023 secondary education curriculum (MoEST, 2023b)
has revealed that comprehensive sexuality education topics in biology for ordinary-
level secondary schools have been reduced to only 2 topics for form four classes
while civics has been abolished by 2027. These changes contradict existing national
and international strategies, policies, and commitments that guide the implementation
of comprehensive sexuality education strategy in Tanzania secondary schools.

The study findings indicates that the inadequate interpretation of SRH education in
the curriculum and the training policy documents may result to inadequate
implementation of SRH intervention strategies in schools. On the other hand, the low
policy priority placed on the role of teachers in fostering the implementation of
school-based SRH intervention strategies in schools may result to the increase of the
negative SRH outcomes among adolescents in schools. As a result, many adolescents
will enter their udulthood with little understanding of how SRH is central to the
 66

overall health and wellbeing. The study findings are consistent with Walker (2020)
who found that inadequate interpretation and implementation of the national and
local SRH policies can lead to inadequate provision of CSE while increasing the
negative SRH outcomes in schools.

4.2.3.2 Limited Resources. The study found that there is a shortage of teaching
and learning resources while on the other hand, there are insufficient human and
financial resources. Teachers are not well equipped with appropriate tools such as
SRH books and manuals or effective training and budgets to support their school-
based SRH interventions. As explained by a teacher from SS1;
We have a shortage of SRH teaching and learning resources,
specialised teachers, and a continuous lack of financial support. In
short, we cannot handle these issues adequately under these
circumstances (Interview, Teacher E, SS1, 19/1/2024).

In addition, a teacher from SS4 articulated;

Adolescents face challenges that need an investment beyond the
classroom (Interview, Teacher S, SS4, 24/1/2024).

The study further revealed that despite a considerable number of qualified teachers
who are potentially available human resources in Dodoma City secondary schools,
only a few teachers possess specialised SRH knowledge and training. Most teachers
engage themselves in the implementation process as part of their teaching role
through biology and civics or personal initiatives as school leaders, parents, and
guardians using their professional experiences and not obliged by formal strategic
roles beyond teaching. As explained by a teacher from SS2;
If teachers were well-utilised and empowered with adequate
resources, perhaps the government could use minimal resources to
combat negative SRH outcomes among in-school adolescents rather
than letting plans and strategies progress conventionally (Interview,
Teacher J, SS2, 22/1/2024).

On the other hand, financial resources limit teachers' efforts to undertake SRH
interventions in schools. The study found among the five schools involved in the
study only one non-government school had a well-stipulated and documented budget.
The rest of the information found in school official records and teachers' responses
 67

during in-depth interviews highlighted financial constraints as a barrier towards

implementing extracurricular programmes, study tours, coordination of school-
community interventions, provision of school-based SRH services, and other school-
based SRH programmes that need financial support. However, in other schools,
teachers declared to receive minimal budgets from their school administrations, and
aid from NGOs, CBOs, and other educational stakeholders. As articulated by a
teacher from SS5;
We do not receive specific budgets for SRH interventions. However,
we are grateful there are times we receive teaching and learning
materials, professional support from medical personnel, and other
aids from the government and NGOs to substitute financial
requirements (Interview, Teacher W, SS5, 25/1/2024).

The lack of adequate resources to teach SRH education comprehensively and

financial support to facilitate school-based SRH interventions impair the capacity of
teachers to implement SRH intervention strategies in schools. As a result,
adolescents in schools continue to suffer from negative SRH outcomes. On the other
hand, the study findings have indicated inadequate specialised SRH education and
services provided by health workers and NGOs, usually in the form of extracurricular
activities most of which are very rare and without priority in the school timetables.
Furthermore, monitoring and evaluation of school-based SRH interventions in
schools also seems to be very limited due to limited resources. As a result, very few
school-based SRH interventions succeed at their full potential.

The study findings are consistent with a study by Keogh et al. (2020) which
highlighted that a lack of well-resourced, prepared, motivated, and comfortable
teachers may result in inadequate implementation of school-based SRH intervention
strategies. Similarly, UNESCO (2023) global education monitoring report on CSE
country profiles revealed that Tanzania has weak levels of responsibility,
decentralisation, and autonomy while data on government budget allocation on
adolescent SRH interventions were not found. Furthermore, the World Bank (2023)
highlighted that Tanzania’s human capital index in 2023 is 39 percent this implies
that a child born in Tanzania will be 39 percent as productive when she grows up as
 68

she could be if she enjoyed complete education and full health. The low human
capital index is due to low investment in young people’s health and education.

The study findings establish the need for adequate and effective investment in
adolescents' SRH and education through prioritising the role of teachers in fostering
the implementation of school-based SRH intervention strategies. Investment in
teachers and adolescents will end the learning crisis that leads to school dropouts,
early marriages, early pregnancies, and low educational attainment among
adolescents. Furthermore, direct investment in teachers and adolescents will ensure
an easy flow of information, resources, and services that will touch adolescents
directly in their schools and communities while enhancing effective educational
leadership in addressing SRH challenges among adolescents in schools.

The study findings align with the East African Community (2016) commitment to
the 2050 development vision that has put much emphasis on education and a high
priority on addressing SRH challenges among adolescents as determinants of human
capital and economic growth. The allocation of school-based SRH intervention
budgets directly to schools will lower implementation costs and ensure sustainable
SRH interventions in Dodoma City secondary schools and other similar contexts.
Direct investment in adolescents' SRH and education will empower teachers to
deliver the best and adolescents to achieve their full potential while driving healthy
and educated young generations in Dodoma City and Tanzania at large.

4.2.3.3 Limited Access to Sexual and Reproductive Health Services. The study
findings indicate that limited access to sexual and reproductive health services is
another barrier facing teachers towards implementing school-based SRH intervention
strategies in Dodoma City secondary schools. The majority of schools that
participated in this study depend on community-based health facilities. A teacher
from SS1 explained;
SRH services in our school are very limited and community health
care facilities are far from the school. Most adolescents face
challenges in accessing such services, some of them miss school
lessons, lack confidentiality, and face excessive bureaucracy in
admission processes (Interview, Teacher D, SS1, 18/1/2024).
 69

Similarly, a teacher from SS4 shared;

Some girls suffer from menstrual cramps and menstrual anxieties.
They lose three to five days out of the class or living uncomfortable
(Interview, Teacher R, SS4, 24/1/2024).

Teachers acknowledge the existing structured collaboration between schools and

community-based health centres in the provision of school-based sexual and
reproductive health care services and the necessity for youth-friendly health services,
but the lack of accessible and reliable SRH services remains a barrier in fostering the
implementation of school-based SRH intervention strategies for adolescents in
schools. As elaborated by a teacher from SS5;
YFHS protocols include joint actions between education and health
workers. However, securing a doctor or a nurse for a referral service
or a guest-speaking programme is not easy. They are very few, busy,
and they have competitive priorities (Interview, Teacher X, SS5,
26/1/2024).

Similarly, a teacher from SS1 elaborated;

We suffer from challenges related to distance and service protocols
such as adolescent admission procedures, cost of services, and service
providers' attitudes (Interview, Teacher B, SS1, 18/1/2024).

Limited access to SRH services increases negative SRH outcomes among in-school
adolescents especially girls. Responses obtained from teachers' in-depth interviews
and documentary review indicated that SRH care services and information are rarely
available in school settings. The only source of relevant SRH information available
for adolescents in schools is what teachers teach in biology and civics; with very few
study tours and guest speakers from health centres and NGOs. On the other hand,
services such as formal guidance and counselling, HIV/AIDS prevention and care,
contraception counselling and provision as well as accessibility to healthcare
facilities were found to be very limited. As a result, the majority of adolescents in
Dodoma City secondary schools lack quality and adequate SRH care services.

The study findings align with the UNFPA (2023) report, which similarly highlighted
that unintended pregnancies tend to be highest among adolescent girls who lack
access to adequate SRH education, contraceptive counselling and provision, and
 70

other SRH care services. Similarly, Nkata et al. (2019) scoping review indicated that
despite the challenges of early pregnancies, STIs, and HIV infections among
adolescents in Tanzania, only one-third of health facilities in Tanzania offer youth-
friendly services. Limited youth-friendly SRH services in Tanzania contribute to the
high prevalence of risky sexual behaviours and their consequences such as early
pregnancies, HIV infections, academic failures, school dropouts, and an increase of
poverty among in-school adolescents and their communities.

The study findings further indicate that limited access to sexual and reproductive
health services in schools results to poor SRH intervention programmes in schools.
Adolescents in schools face limited access to contraceptives and comprehensive
sexuality education. As a result, many adolescents continue to engage in risky sexual
behaviours and practices such as multiple and concurrent partnerships and
inconsistent condom use. The study findings are also consistent with Kishaluli and
Mollel (2023) who found that inadequate access to SRH information, contraceptives,
and friendly services among adolescents increase the rate of early pregnancies and
school dropouts. The study findings establish the need for school-based health
centres to enhance adolescents' access to SRH care services.

4.2.3.4 Unfriendly School Environments. Despite, the Tanzania National School

Health Policy guidelines and commitments to the provision of friendly and
supportive health environments in schools, the study findings revealed that the
majority of schools that participated in this study have unfriendly school
environments (both physical and social). Three out of five schools found to have a
shortage of important buildings such as administration blocks, teachers' offices,
emergency rooms, guidance and counselling rooms, and infirmaries. This indicates a
lack of a safe and supportive SRH environment for in-school adolescents. As
explained by a teacher from SS2;
The overall physical and social environment in our school does not
allow effective and adequate implementation of SRH interventions
strategies. Some SRH issues demand privacy and confidentiality
which the school environment does not guarantee (Interview, Teacher
H, SS2, 19/1/2024).
 71

The lack of supportive physical infrastructures in Dodoma City secondary schools

creates unsafe social environments for teachers and adolescents. Overcrowded
classes and lack of privacy and confidentiality reduce teacher-student positive and
active interaction during and after SRH lessons. As articulated by a teacher from
SS3;
The large number of students in our few offices and classrooms is a
big challenge. For example, in form one class active students are
more than 400 divided into four streams; it is not easy to manage one
hundred students in a single class, or handle their personal SRH
issues under the tree (Interview, Teacher K, SS3, 22/1/2024).

The physical and social environment in Dodoma City secondary schools does not
guarantee safety and enough care to support teachers to offer effective psychosocial
support and health care for in-school adolescents during SRH emergencies. As a
teacher from SS5 conveyed;
We do not have emergency and special care rooms. I remember one
day a girl had her first bleeding in a classroom and she was not
aware; other students laughed at her. The solution was a quick run to
the toilets, which are not safe at all. She also had no pads and that
day the school ran out of stock. It was embarrassing; thereafter the
girl returned home and got back to school after a week (Interview,
Teacher U, SS5, 25/1/2024).

The lack of safe and supportive school environments for adolescents impairs
effective SRH teaching and learning while increasing vulnerability among
adolescents in Dodoma City secondary schools. For instance, the study found
teachers handle student guidance and counselling cases in open spaces without
privacy and confidentiality. As explained by a teacher from SS4;
We handle most of SRH cases and issues under trees or in the staff
and classrooms. This is so challenging, sometimes it creates fear and
unethical issues between teachers and adolescents (Interview,
Teacher P, SS4, 23/1/2024).

Teachers' responses highlighted vulnerability issues among adolescents including

hiding their SRH concerns and problems because of environmental barriers. This
may increase SRH knowledge gaps and risky sexual behaviours among adolescents
in schools or delay teachers' interventions. As explained by a teacher from SS3;
 72

Discussing SRH issues under the tree or in open spaces is so

challenging. Some adolescents choose to hide their problems due to
lack of confidentiality (Interview, Teacher L, SS3, 22/1/2024).

Similarly, a teacher from SS2 expressed;

Some adolescents walk a long distance to school, which increases
vulnerability to negative SRH outcomes; leading to poor attendance,
school dropouts, early pregnancies, and early marriages (Interview,
Teacher F, SS2, 19/1/2024).

The study findings have revealed that unfriendly school environments result to
inadequate implementation of school-based SRH intervention strategies. The
identified shortage of important offices, emergency rooms, counselling rooms, and
the limited resources affect the provision of guidance and counselling services,
comprehensive sexuality education, and may result to inconsistent parental and
community involvement in school-based SRH interventions. This increases
adolescents' vulnerabilities to the negative SRH outcomes such as sexual violence,
early pregnancies, and school dropouts. The study findings are consistent with
Walker (2020) who found that unsupportive school environments reduce the capacity
of teachers to implement adequate SRH intervention strategies in schools. Similarly,
the study findings align with MoHCDGEC (2021a) which highlighted that
inadequate infrastructure for adolescent SRH services impair efforts to reduce the
negative SRH outcomes among adolescents.

As a result, adolescents in schools continue to suffer from a lack of basic SRH

knowledge, poor school attendance, and lower education attainment. Lower
education levels reduce the power of adolescents to fight against the negative sexual
and reproductive health outcomes such as early pregnancies and HIV infections as
well as failure to maintain a healthy and responsible adult life. The study findings
highlight the need to prioritise the role of teachers in fostering the implementation of
school-based SRH intervention strategies to ensure health friendly school
environments for adolescents. The study findings underscore the UNAIDS (2023)
Global AIDS update which revealed that an unsupportive school environments affect
the implementation of SRH intervention strategies in schools.
 73

Creating healthy and friendly school environments where adolescents feel safe,
supported, and empowered, will foster a school culture that values open
communication, respect, and inclusivity regarding SRH service provision among
adolescents in schools. Such an environment includes both the physical and social
dimensions and enables promotion of positive SRH behaviours, healthy interpersonal
relationships, academic achievements, and freedom from sexual abuse and
discrimination. It is an essential factor that will enable teachers to achieve the overall
SRH interventions in schools. This can be achieved through SRH policies that
embrace the role of teachers effectively, effective implementation plans, and training
for evidence-based intervention strategies for for teachers and adolescents.

4.2.4 Implications of the Study Findings

The findings of this study have implications for existing knowledge, for adolescents
SRH and education, for policy and practice as well as for other areas of study.

4.2.4.1 Implications for Existing Knowledge. The identified perceived role of

teachers, school-based SRH intervention strategies employed by teachers, and the
barriers facing teachers in the implementation of school-based SRH intervention
strategies for adolescents in Dodoma City secondary schools, contribute to a broader
understanding of the role of teachers in fostering the adequate implementation of
school-based SRH intervention strategies. The study advocates for a strategic shift in
focus by emphasising the centrality of the role of teachers in the implementation of
school-based SRH intervention strategies for adolescents, which adds a new
perspective to the existing literature.

4.2.4.2 Implications for Adolescents SRH and Education. The study findings
will improve SRH among in-school adolescents. Adequate and effective
implementation of school-based SRH interventions will enhance the availability and
accessibility of SRH services in schools. The active role of teachers in fostering
effective parental and community participation, resource mobilisation, and friendly
school environments may increase adolescents' social security and support. This may
reduce school dropouts, HIV infections, early marriages, early pregnancies, STIs,
and sexual violence among adolescents in Dodoma City secondary schools.
 74

Eventually, it will lead to healthy, well-educated, developed, and responsible adults

in Dodoma City communities and other similar contexts in Tanzania.

4.2.4.3 Implications for Policy and Practice. The study findings may have an
impact on educational policy and practices. Prioritising the role of teachers in
implementing school-based SRH interventions may influence SRH policy reforms,
curriculum development, and teacher’s professional development in Dodoma City
and other similar settings. Furthermore, the findings of this study can influence the
government of Tanzania, teachers, school administrators, health workers, school
health task forces, educational policymakers, and other related stakeholders to design
and implement school-based SRH interventions that prioritise the role of teachers in
the implementation process.

4.2.4.4 Implications in Other Areas of Study. The implementation of school-

based sexual and reproductive health intervention strategies involves a
multidisciplinary approach, the findings and insights gained from this study may
have relevance and influence or applicability to public health, project planning,
community development, and social work studies.
 75

CHAPTER FIVE
SUMMARY, CONCLUSION, AND RECOMMENDATIONS

5. Introduction

Chapter five presents a summary of the study, a summary of the key findings,
conclusion, and recommendations.

5.1 Summary of the study

The purpose of this study was to explore the role of teachers in fostering the
implementation of school-based SRH intervention strategies for adolescents in
Dodoma City secondary schools. The study specific focus was on the perceived role
of teachers, strategies employed by teachers, and barriers facing teachers in the
implementation of school-based SRH intervention strategies for adolescents. Guided
by the ecological systems theory and informed by existing literature, the study
employed a qualitative research approach in a single case study design to explore the
research problem in its naturally occurring context. Twenty-five teachers and five
secondary schools in Dodoma City were involved in the study purposively.

Data collection utilised in-depth interviews and documentary review. Data analysis
involved thematic analysis strategies. The study findings revealed that teachers in
Dodoma City secondary schools understand their role in designing and implementing
school-based SRH intervention programmes, community coordination, collaboration,
and partnership, being the reliable formal sources of SRH information, advocacy,
and referral. Furthermore, teachers in Dodoma City secondary schools play a
significant role in fostering the implementation of CSE, guidance and counselling,
parental and community involvement, and peer education strategies. However,
inadequate school-based SRH policy interpretations, limited resources, limited
access to SRH services, and unfriendly school environments impair their capacity.

5.2 Summary of the Key Findings

The study aimed to achieve three specific objectives. The first objective aimed to
explore the perceived role of teachers in fostering the implementation of school-
based SRH intervention strategies for adolescents in Dodoma City secondary
schools. The study found that teachers understand their role as designers and
 76

implementers of school-based SRH intervention programmes, reliable formal sources

of SRH knowledge in schools, coordinators of school-community collaboration and
partnership, advocates and referral systems of adolescents regarding sexual and
reproductive health in Dodoma City secondary schools. The study findings revealed
that the majority of the study participants' perceived role aligns with the actual role
highlighted in the existing literature, policies, and strategies reviewed in this study.
The perceived role of teachers is associated with their SRH knowledge and
intervention experience together with strong self-motivation, commitment, and
determination to help adolescents in schools to stay healthy and educated.

The second objective aimed to examine strategies utilised by teachers to implement

school-based SRH interventions for adolescents in Dodoma City secondary schools.
The study found that comprehensive sexuality education, guidance and counselling,
parental and community involvement, and peer education are the key school-based
SRH intervention strategies utilised by teachers in Dodoma City secondary schools.
The identified school-based SRH intervention strategies indicate that teachers play a
significant role in implementing SRH intervention strategies that aim at helping
adolescents in schools to overcome the negative SRH outcomes from the individual
to the societal levels. However, the role of teachers is underutilised due to inadequate
policy interpretations, limited resources, and unfriendly school environments.

The third objective aimed to investigate barriers facing teachers in the

implementation of school-based SRH intervention strategies for adolescents in
Dodoma City secondary schools. The study findings revealed inadequate school-
based SRH policy interpretations, limited resources, limited access to sexual and
reproductive health services, and unfriendly school environments as the key barriers
facing teachers in the implementation of school-based SRH intervention strategies in
Dodoma City secondary schools. The identified barriers lead to informal
implementation structures, poor coordination of implementation activities, low
investment in school-based SRH interventions, and the failure of teachers to deliver
their full potential in fostering the implementation of school-based SRH intervention
strategies for adolescents in schools. As a result, the implementation of school-based
SRH intervention strategies in Dodoma City secondary schools remains inadequate.
 77

5.3 Conclusion

Based on the study findings and the three research objectives/questions, the
following conclusion can be made;

The first research question intended to know the perceived role of teachers in
fostering the implementation of school-based SRH intervention strategies for
adolescents in Dodoma City secondary schools. The study findings conclude that
teachers' SRH knowledge and intervention experience can influence teachers' self-
awareness, determination, commitment, motivation, empowerment, and
accountability in helping adolescents in schools to stay healthy and educated.
Therefore, effective and adequate utilisation of the role of teachers in designing and
implementing school-based SRH intervention programmes from the microsystem
level to the macro and chronosystem levels will ensure large-scale, sustainable, cost-
effective, and more focused SRH interventions in Dodoma City secondary schools.

The second research question aimed to know how teachers implement school-based
SRH interventions for adolescents in Dodoma City secondary schools. The study
findings have established that the utilisation of any school-based SRH intervention
strategy for adolescents in Dodoma City secondary schools depends much on the role
of teachers in fostering the implementation process at all levels of the ecological
systems. Therefore, to achieve adequate and effective implementation of school-
based SRH intervention strategies in Dodoma City secondary schools, policymakers
need to accommodate the role of teachers effectively in the implementation process.
Teacher-centred school-based SRH intervention strategies will adequately reduce the
negative SRH outcomes among adolescents in Dodoma City secondary schools.

The third research question aimed to know the barriers facing teachers in the
implementation of school-based SRH intervention strategies for adolescents in
Dodoma City secondary schools. The study findings conclude that most barriers
facing teachers are caused by the underutilisation of the role of teachers in the
implementation process. Therefore, prioritising the role of teachers will ensure
adequate implementation of school-based SRH intervention strategies in Dodoma
City secondary schools while reducing implementation barriers at all levels of the
 78

ecological systems. Prioritising the role of teachers in school-based SRH policies,

intervention budgets, and strategic plans will enhance adequate policy interpretations
and effective investment in adolescents' health and education. In addition, adequate
utilisation of the role of teachers will facilitate effective community participation,
resource mobilisation and utilisation as well as safe and supportive school
environments.

5.4 Recommendations

The study presents recommendations for policy and practice, for other research
methods, and for further studies.

5.4.1 Recommendations for Policy and Practice

Based on the study findings, the researcher recommends the government of

Tanzania, specifically the Ministry of Health, the Ministry of Community
development, Gender, Women, and Special Groups, the Ministry of Education,
Science, and Technology, the President’s Office Regional Administration and Local
Government, the Dodoma regional, district, and ward school health task forces,
donors, school owners, school administrators, teachers, and all SRH related
stakeholders in Dodoma City;

 To prioritise the role of teachers in school-based SRH policy making,

interpretations, and implementation

 To allocate school-based SRH intervention budgets direct in schools (to

reduce barriers and ensure adequate SRH service delivery in schools)

 To ensure safe and friendly environments in Dodoma City secondary schools

 To encourage the Ministry of Education, Science, and Technology to review

the 2023 ordinary level secondary education curriculum so as to engage SRH
education comprehensively

 To establish an effective school-based SRH intervention system that will

enable teachers and other related stakeholders to work together efficiently

 To develop a school-based health report system (that will enable teachers to

record and report SRH implementation activities daily)
 79

 To make sure school-based SRH teaching and learning materials address

adolescents' SRH needs timely, while widely disseminated, digitalised,
reliable, and accessible to all teachers, adolescents, and stakeholders

 To encourage school-based SRH research and training to enable teachers and

other related stakeholders to make informed and evidence-based interventions
that provide sustainable SRH solutions among adolescents in schools

5.4.2 Recommendations for Other Research Methods

Based on the findings of this study, the researcher recommends other research
methods such as comparative studies to identify best practices and other factors
contributing to adequate implementation of school-based SRH intervention strategies
in Dodoma City secondary schools and other similar contexts.

5.4.3 Recommendations for Further Studies

In relation to the findings of this study, the researcher suggests further research on
the following topics:
 The role of teachers in designing and implementing school-based SRH
intervention programmes for adolescents in Dodoma City secondary schools

 The role of teachers in implementing SRH guidance and counselling services

for adolescents in Dodoma City secondary schools

 The role of regional administrations and local government authorities in

implementing SRH interventions in Dodoma City secondary schools

 The impact of the 2023 secondary education curriculum changes on the

provision of comprehensive sexuality education in Tanzania secondary
schools

 The effectiveness of the Tanzania national school health policy in facilitating

sexual and reproductive health interventions in Tanzania secondary schools

Addressing the above topics will enhance the capacity and role of teachers in
promoting the development of healthy and academically successful adolescents in
Dodoma City secondary schools. Also it will lead to healthy, educated, and
responsible adults in Dodoma City communities and Tanzania at large.
 80

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 88

APPENDICES
APPENDIX A
RESEARCH TIME TABLE
Month Year Activity
February-July 2023 Research proposal writing
August-November 2023 Research proposal presentation
November-December 2023 Proposal submission and research clearance
January-April 2024 Data collection, analysis, and report writing
May 2024 Presentation of research findings
June 2024 Final report writing and submission
 89

APPENDIX B
RESEARCH BUDGET
S/n Item Cost (Tsh)
1. Research proposal writing 600,000/=
2. Data collection 1,500,000/=
3. Data Analysis 400,000/=
4. Report Writing 600,000/=
5. Stationery 400,000/=
6. Assistance 500,000/=
Total 4,000,000/=
Source of fund Own source
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APPENDIX C
 91

APPENDIX D
 92

APPENDIX E
 93

APPENDIX F
Review of Content Related to SRH in the 2005 Biology Syllabus for Ordinary
Secondary Education Form I-IV

Class Topics Specific objectives Period

Form HEALTH AND Student should be able to:
One IMMUNITY Explain the concept of health and immunity
The Concept of Mention types of body immunity and their importance 4
Health and State factors which affect body immunity
Immunity
Personal Explain the meaning of personal hygiene and good manners
Hygiene and Explain the importance of personal hygiene and good
Good Manners manners
Outline principles of personal hygiene and good manners
Mention requirements of personal hygiene and good 12
manners
Outline ways of maintaining proper personal hygiene
during puberty
Infections and Explain the meaning of infection and disease
Diseases Mention common infections and diseases
Explain the causes, symptoms, modes of transmission, and 6
effects of common infections and diseases
Human Immuno Explain the meaning of HIV/AIDS, STIs, & STDs
Deficiency Virus Explain cause, symptoms, mode of transmission and effects
(HIV) of HIV/AIDS, STDs, & STDs 6
Outline preventive and control measures of HIV/AIDS,
STIs, & STDs
Management of Explain ways of avoiding risky situations, behaviours, and
STIs, HIV and practices
AIDS Demonstrate necessary skills for avoiding risky situations,
behaviours, and practices 6
Explain the importance of curative health care for STIs and
opportunistic diseases
Care and Support Explain the importance of providing care, support, and
for People services for PLWHA in the school, family, and community
Living with HIV 6
and AIDS
(PLWHA)
Form
No SRH Topics
Two
Form REPRODUCTI Student should be able to:
Three ON Explain the concept of reproduction 2
The Concept of
Reproduction
Reproduction in Identify the parts of the male and female reproductive
Mammals organs 4
Describe male and female reproductive systems
Gamete Explain the process of ovulation and menstruation
Formation and Explain the process of fertilisation, pregnancy, and child 4
Fertilisation birth
Disorders of Mention types of disorders of human reproductive system
Reproductive Explain the causes and effects of the reproductive system 6
Systems disorders
Suggest possible remedies of reproductive system disorder
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Complications of Mention types of complications of the reproductive system

the Reproductive Outline causes of complications of the reproductive system
System Suggest ways to minimize the occurrence of complications
and disorders of the reproductive system 6
Sexuality, Sexual Explain concept of sexuality
Health, and Mention social cultural factors influencing sexual behaviour
Responsible in age group of people
Sexual Differentiating responsible from irresponsible sexual
Behaviours behaviour and their impact on oneself family and
community 4
Suggest ways of eradicating irresponsible sexual
behaviours/practices in the family and community
Mention appropriate life skills required to cope with
adolescent sexuality and sexual behaviour
Family Planning Explain the concept of family planning and contraception
and State social cultural practices which enhance family
Contraception planning 4
Outline the importance of male involvement in family
planning
Maternal and Explain the concept of maternal and child care
Child Care Mention the cultural factors which affect maternal and child
care in the family and community 4
Suggest appropriate ways of providing maternal and child
care for PLWHA
Form GROWTH Student should be able to:
Four Growth and Explain the concept of growth and development in human
Development being
Stages in Human Explain physiological, psychological, and behaviour
changes associated with growth and development in
childhood, adolescence, reproductive age, middle, and old 6
age
Outline factors which affect the rate of physical
deterioration of human body and services required to meet
the needs of an individual at each stage
Human Immuno Student should be able to:
Deficiency Virus Distinguish between HIV, AIDS, and STIs
(HIV)
Relationship Explain the relationship between HIV, AIDS, and STIs 4
between HIV,
AIDS, and STIs
Management and Outline ways of managing and controlling HIV, AIDS, and
Control of HIV, STIs
AIDS, and STIs Mention the life skills needed for home-based care for
PLWHA 6
Mention precaution to be taken when handling PLWHA
and STIs
Voluntary Explain the concept of voluntary counselling and testing
Counselling and Outline the significance of VCT in the control and
Testing prevention of HIV, AIDS, and STIs 6
Explain the procedures and techniques of VCT for HIV and
AIDS

Source: MoEVT (2005a)

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APPENDIX G
Review of Content Related to SRH in the 2005 Civics Syllabus for Ordinary
Secondary Education Form I-IV

Class Topics Specific Objectives Periods

Form PROMOTION Student should be able to:
One OF LIFE Explain the meaning and types of life skills
SKILLS Illustrate the importance of life skills
Meaning and Demonstrate how to use social skills 39
Types of Life Analyse the consequences of not applying social
Skills skills
HUMAN Define human rights
RIGHTS Explain various aspects of human rights
Aspects of Human Explain the importance of human rights in our society
Rights Relate human rights in the provision of basic needs 8
Explain the role of government and different pressure
groups in the promotion of human rights in Tanzania
Limitations of Explain the meaning and purpose of limitations of
Individual Human individual human rights 4
Rights
Human Right Explain the meaning and effects of human rights 5
Abuse abuse
FAMILY LIFE Define family and identify types of families
The concept of Analyse the importance of family 4
family Identify factors contributing to family stability
Courtship and Explain the meaning and importance of courtship
Marriage Explain the relationship between courtship and
marriage
Identify customs and beliefs that encourage 5
premature/early marriages
Identify foundation of a stable marriage
Rights and Analyse the rights and responsibilities of each
Responsibilities of member in the family
Family Members Assess the consequences of failure by family 5
members to carry out their responsibilities
PROPER
BEHAVIOUR
AND
RESPONSIBLE
DECISION
MAKING
Meaning and Explain the meaning and types of behaviour 10
Types of
Behaviour
Elements of Proper Identify elements or indicators of proper behaviour
Behaviour Analyse consequences of behaviour to him/herself
and others
Explain the importance of behaving properly
Responsible Explain the meaning and importance of responsible
Decision Making decision making
Illustrate skills needed to make healthy decision 11
 96

Form PROMOTION Student should be able to:

Two OF LIFE Explain the meaning and importance of applying
SKILLS problem solving technique 6
Social Problem- Identify steps in the problem-solving process
Solving Technique Practice solving problem
GENDER Identify different concepts of gender
The Concept of Identify gender issues in the society
Gender Describe social cultural practices that hinder equal
participation between men and women in our society 26
Suggest corrective measures against negative social
cultural practices
Form PROMOTION Explain the importance of good leadership, team
Three OF LIFE work, positive relationship, self-worth, and
SKILLS confidence
Good Leadership, Demonstrate good leadership, team work, positive
Team Work, relationship, self-worth, and confidence 25
Positive
Relationship, Self-
Worth, and
Confidence
Form CULTURE Student should be able to:
Four Aspects and Explain the meaning and aspect of culture
Elements of Analyse the elements of culture 20
Culture Illustrate the importance of each element of culture
Positive and Identify positive and negative aspects of our cultural
Negative Aspects values
of Our Cultural Analyse customs which lead to gender discrimination
Values Point out customs and practices that lead to the spread
of HIV/AIDS and STIs 40
Analyse the impact of the negative aspects of our
customs
Propose ways and actions to be taken against negative
aspects of our socio-cultural values
Promotion of Life Explain the meaning of life skills and demonstrate 35
Skills how to use different life skills

Source: MoEVT (2005b)

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APPENDIX H

Review of Content Related to SRH in the 2023 Curriculum for Ordinary

Secondary Education Form I-IV

SRH Topics in the 2023 Curriculum

Subjects Class Topics Specific Objectives Periods
Biology Form One No SRH topics 0
Form Two No SRH topics 0
Form Three No SRH topics 0
Form Four Reproduction Student should be able to: Not
in Humans Describe reproduction in specified
humans, fertilisation,
pregnancy, and child birth

Growth and Describe the mechanism of

Development growth and development
in Humans stages in human
Civics Abolished
Other No SRH topics

Source: MoEST (2023a), MoEST (2023b) and Field Data (2024)

 98

APPENDIX I

Review of the 2018-2023 Policy Guidelines on School Health Services in

Tanzania

The National School Health Programme (NSHP)

Coordination Level Who is Accountable Role

National Level MoH Overall management
Permanent Secretary Resource mobilisation
Chief Medical Officer
Director of Preventive Service
Assistant Director Health Promotion
Section
MoEST Curriculum development for
Permanent Secretary health instructions
Commissioner for Education Capacity building for
Director Secondary Education teachers
Monitoring and evaluation
Quality assurance
PO-RALG Policy coordination
Not specified Infrastructure management
Inclusion of interventions
NSH-Secretariat
PO-RALG Not specified
UN and Donors
NGOs
Research Institutes
CSOs
Agencies
Technical Advisory Committee Resource mobilisation and
(TAC) utilisation
Director of Preventive Services Monitoring and evaluation
(MoH) Policy Review
Health Sector sub-Committee Reviewing all interventions
Various Health Sector Stakeholders and strategies
Provide technical input
Education Sector sub- Provide technical input
Committee Maintaining the standard of
Various Education Sector learning environment and
Stakeholders materials
School Health To raise the profile of the
Ambassador/Champion national school health
Dignitaries and Celebrities programme
Regional Level Regional School Health Task Ensuring school health
Force services and interventions
Representatives from Health, reach all learners
Education, and Local Government Identifying most
Sectors disadvantageous schools
Resource mobilisation
Advocacy and promotion of
school health initiatives
 99

Linking ministerial
departments and agencies,
NGOs and CBOs
Provide technical support to
local government
District Level District School Health Task To ensure the
Force implementation of NSHP in
District School Health Coordinator schools (with clear objectives
and indicators)
Overseeing school health
policy and services
Coordination of partners
Ensuring progressive
coverage of all schools and
learners
Reporting school health
activities
Strengthening
communication systems
Capacity building of health
professionals and educators
Ward Level Ward School Health Task Implementation of the annual
Force and five-year strategies
Ward Health Officer Supervision of
Ward Executive Officer implementation at school
Ward Education Coordinator level
Monitoring and evaluation of
implementation activities
School and Schools and Communities Coordination, collaboration,
Community Level Teachers and partnership in both
Students school and community-based
Parents health programmes
School Board Involvement in daily school
Head of Schools health and education
All School Staff Sharing of information and
Community Members best practices
Social Welfare Officers Promoting advocacy
Community Development Officers Adherence to operating
Community-based Health Workers procedures and standards
Guiding and protecting
children
Provide security and enabling
environment
Development Donor Countries Providing technical and
Partners and International Organisations resource support to
NGOs strengthen the NSHP
Private Sector CBOS
Private Institutions
Citizens
Training and Universities Providing evidence for
Research Colleges improving performance
Research Institutes Produce competent teachers
Institutions

Source: MoHCDGEC & MoEST (2018) and Field Data (2024)

 100

APPENDIX J
INSTITUTIONAL REVIEW AND APPROVAL
101
 102

APPENDIX K
RESEARCH CLEARANCE
103
104