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School-based programmes to combat the spread of HIV have been demonstrated to be effective over the short-term (i.e. 6-24 months), but few studies have addressed the sustainability of such interventions. Primary School Action for Better Health (PSABH) is an intervention delivered in upper primary-school grades in Kenya using regular classroom subjects and co-curricular activities. This paper reports results of an evaluation to assess the sustainability of PSABH and its impacts three years after teachers were trained in its delivery. Twenty primary schools participated in a pre-post evaluation of PSABH in Kenya over three consecutive school years. Surveys were completed by teachers (n = 40), pupils (n = 3403), and Quality Assurance Officers (n = 15); focus groups were held with pupils, and in-depth interviews with teachers. Teachers continued to deliver programme components three years after they were trained. Gains demonstrated in pupil knowledge, attitudes and risk-reducing sexual behaviours after one-and-a-half years of programme implementation were replicated in the third year of the intervention with additional gains in attitudes related to condoms and girls' reported use of condoms. These results support the conclusion that PSABH and its impact on student knowledge, attitudes and behaviour is sustainable across at least three school years and three student cohorts. (Contains 1 note and 7 tables.)

This study examined the impact of a primary-school HIV education initiative on the knowledge, self-efficacy and sexual and condom use activities of upper primary-school pupils in Kenya. A quasi-experimental mixed qualitative-quantitative pre- and 18-month post-design using 40 intervention and 40 matched control schools demonstrated significant program impact on targeted objectives of (1) adequate program delivery and, for standard 6 and 7 pupils (ages 11-16 years), (2) increased HIV-related knowledge; (3) increased communication with parents and teachers about HIV and sexuality; (4) increased assistance to fellow pupils to avoid sexual activity; (5) increased self-efficacy related to abstinence and condom use; (6) decreased exposure to HIV through delayed first intercourse, decreased sexual activity and increased condom. Results support the conclusions that the existing infrastructure is adequate for national roll-out of the program; that the program has its most beneficial effect on sexually inexperienced youth and should therefore be implemented with the youngest age groups possible; and that gains are gender specific, with boys reporting increased condom use while girls are more likely to decrease or delay sexual activity. Based on these results, the program began national roll-out to all primary schools in 2005. By June 2006, the program was operating in 11,000 of the country's nearly 19,000 schools. (Contains 6 tables.)

Background/Context: The UN Sustainable Development Goals include a renewed commitment to inclusive and equitable education for all and will maintain pressure on governments in low-income countries to ensure this provision. A range of prominent researchers and institutional actors continue to explore and to promote low-fee private schools (LFPSs) as a viable option for achieving universal access to basic education. The emphasis on LFPSs can be seen as part of the push for education policies that attempt to improve educational access and quality not through the strengthening of public education but through the establishment of public-private partnerships. Focus of Study: In this paper we explore the Kenyan government's engagement with LFPSs, document and assess the impact of this support on the behavior of LFPS and clarify key actor perspectives and responses within this context. Research Design: Through a qualitative case study of two LFPSs in a large urban informal settlement near Nairobi, we focus on the dynamic interaction and delicate equilibrium within which government officials, LFPS representatives, parents, and students not only interact with but influence each other. Data for the study were gathered over the course of 8 weeks during May and June of 2010 in the urban slum called Mathare Village in Nairobi through document review, 35 interviews, and school visits. Conclusions: The findings suggest that LFPSs do not function in practice as in theory, and crucially, that there are inherent trade-offs, tensions, and unexpected dynamics in operation that have serious consequences for such issues as quality and equity, even when supported by formal government policy designed to address these aspects. The study reinforces the importance of national governments and international bodies increasing the resources devoted to improving access to, and the quality of, public education.