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Comprehensive sexuality education (CSE) is a key component of efforts to improve sexual and reproductive outcomes for young people. While many governments have established policies and curricula for CSE, there are no quantitative measures of the quality of their implementation in schools. We describe the construction of a school-level index to measure CSE implementation quality using data from Peru, Guatemala, Kenya and Ghana for validation. The composite index represents seven key components of a successful programme: range of topics, values imparted, teaching methods, teacher training, resources available, monitoring and evaluation, and the school environment. These components are combined into two sub-indices (curriculum content and implementation context), which together provide a summary index of implementation quality. We present scores for the seven components, the two sub-indices and the summary index for each country. Ghana scored highest on the summary index, while Guatemala scored lowest, but country rankings varied within the different components. The paper discusses the implications of the findings for improving school-based CSE in these countries. An assessment of the validity and reliability of the index indicates it can be used in other settings and could be a useful tool for educationalists, researchers and programme implementers to measure CSE implementation quality. [ABSTRACT FROM AUTHOR]

The successful implementation of comprehensive sexuality education (CSE) programmes in schools depends on the development and implementation of strong policy in support of CSE. This paper offers a comparative analysis of the policy environment governing school-based CSE in four low- and middle-income countries at different stages of programme implementation: Ghana, Peru, Kenya and Guatemala. Based on an analysis of current policy and legal frameworks, key informant interviews and recent regional reviews, the analysis focuses on seven policy-related levers that contribute to successful school-based sexuality education programmes. The levers cover policy development trends; current policy and legal frameworks for sexuality education; international commitments affecting CSE policies; the various actors involved in shaping CSE; and the partnerships and coalitions of actors that influence CSE policy. Our analysis shows that all four countries benefit from a policy environment that, if properly leveraged, could lead to a stronger implementation of CSE in schools. However, each faces several key challenges that must be addressed to ensure the health and wellbeing of their young people. Latin American and African countries show notable differences in the development and evolution of their CSE policy environments, providing valuable insights for programme development and implementation. [ABSTRACT FROM AUTHOR]

School-based comprehensive sexuality education (CSE) can help adolescents achieve their full potential and realize their sexual and reproductive health and rights. This is particularly pressing in low- and middle-income countries (LMICs), where high rates of unintended pregnancy and STIs among adolescents can limit countries’ ability to capitalize on the demographic dividend. While many LMICs have developed CSE curricula, their full implementation is often hindered by challenges around program planning and roll-out at the national and local level. A better understanding of these barriers, and similarities and differences across countries, can help devise strategies to improve implementation; yet few studies have examined these barriers. This paper analyzes the challenges to the implementation of national CSE curricula in four LMICs: Ghana, Kenya, Peru and Guatemala. It presents qualitative findings from in-depth interviews with central and local government officials, civil society representatives, and community level stakeholders ranging from religious leaders to youth representatives. Qualitative findings are complemented by quantitative results from surveys of principals, teachers who teach CSE topics, and students aged 15–17 in a representative sample of 60–80 secondary schools distributed across three regions in each country, for a total of around 3000 students per country. Challenges encountered were strikingly similar across countries. Program planning-related challenges included insufficient and piecemeal funding for CSE; lack of coordination of the various efforts by central and local government, NGOs and development partners; and inadequate systems for monitoring and evaluating teachers and students on CSE. Curriculum implementation-related challenges included inadequate weight given to CSE when integrated into other subjects, insufficient adaptation of the curriculum to local contexts, and limited stakeholder participation in curriculum development. While challenges were similar across countries, the strategies used to overcome them were different, and offer useful lessons to improve implementation for these and other low- and middle-income countries facing similar challenges. [ABSTRACT FROM AUTHOR]