South Africa: A new chapter for school-based sexual and reproductive health services needed

Wednesday, June 14, 2017 — DURBAN 

The Department of Basic Education (DBE) will today announce the finalisation of the commendable learner health policy that could open the way for critically important sexual and reproductive healthcare (SRH) services to be delivered in South African schools, the international medical humanitarian organisation Doctors Without Borders (MSF) is calling on the DBE, Provincial Departments of Education and School Governing Bodies (SGBs) to overcome the longstanding barriers of the past and move positively into the future by implementing these news guidelines, and ensure that learners can finally benefit from needed comprehensive school-based SRH services. The Integrated Policy on HIV, TB and STIs is a big step forward and reaffirms the government’s commitment to the delivery of a comprehensive care package for learners, including general health education, HIV counselling, testing, provision of contraception and PrEP as well as screening for TB and sexually transmitted illnesses (STI ) in schools. Importantly, it moves on from the 2011 Integrated School Health Policy (ISHP), which was co-developed by the DBE and the Department of Health, by clarifying that implementation is not the domain of SGBs. Until now SGBs in some Districts have blocked the full implementation of the ISHP in schools, particularly the distribution of condoms and contraceptives to learners.

Despite the many progressive elements of the policy, it still remains unclear how these vital services will be resourced and implemented. The need for SRH services in schools is clear and urgent, but until now implementation has been held back by a combination of policy gaps and some resistance to these services on the local level. This means that much of the opportunity to protect school children from HIV has been missed,” says Dr. Amir Shroufi, MSF’s medical co-ordinator in South Africa. “There is also a strong need to educate and clear common misconceptions among parents, principals and teachers around what services will be offered in schools, and why it is in the best interests of their children that they support access to these services.”

A 2011 HIV impact population survey conducted by MSF in Uthungula District in KwaZulu-Natal found that youth under 29 years are driving the HIV epidemic, with fewer HIV positive young men and women aware of their status compared with other populations. HIV prevalence was shown climbing from 5% in 18 year olds to over 20% in 19 year olds – a clear basis for the provision of SRH services in schools.

‘Some learners are sexually active and need protection. But it’s the massive jump in HIV prevalence that occurs after learners leave school that makes these services so necessary. This tells you that we need to start moulding new behaviour in schools, particularly among males, by providing learners with sexual health education and getting them into the habit of using preventive services,’ says Musa Ndlovu, Deputy Field Coordinator in MSF’s HIV/TB project in Uthungula District.

With the Integrated Policy on HIV, TB and STIs already approved by the Cabinet of South Africa, MSF urges the DBE to revise the 2012-2016 Integrated Strategy on HIV, TB and STIs to bring it in line with the new policy and provide clear guidance on how Provincial Departments of Education can practically deliver SRH services in schools. Provincial Departments will then need to ensure that appropriately funded and resourced implementation plans are put in place, with clear responsibilities and accountability for delivery at district levels.

Successful multi-partner SRH schools programs already exist in South Africa, and the evidence and lessons from these should be shared and studied to ensure that schoolchildren receive the protection they need.  MSF currently runs two school health programs in different areas of the country, both in partnership with local authorities and health facilities. These programmes demonstrate that working in partnership with Departments of Education and health, local leaders, school principals, parents and members of SGBs, it is possible to provide comprehensive SRH services to learners.

Note to Editors:

MSF’s school health programs are based in uThungula District (KwaZulu Natal, started 2012) and Khayelitsha (Western Cape, started 2016).

uThungula District (specifically Eshowe and Mbongolwane): In 2016, MSF health education reached 38 schools and 17,160 learners, 43 % of  whom were tested, and are now regularly re-testing. Of the 7,412 students that were tested, 7312 were HIV negative and 93 HIV positive. 93 students were linked to care and referred for the prescription of antiretroviral treatment. The Schools program in Eshowe has been active since 2012  and initially, each visit commenced with health education in the classes, followed by HIV counselling and testing for those students who chose to test. Schools allocated three days per visit, but this proved insufficient for ongoing support and care, and gave rise to the training of Learner Support Agents to function as HIV/TB focal persons in schools.

Khayelitsha: In January 2016, a school principal informed MSF that 8 female learners were pregnant and were returning to school for the New Year. The school, a local primary health care clinic and the City of Cape Town Health Services department embarked, in partnership with MSF, on an intensive outreach programme. Using the ISHP as a guide, an integrated, youth-focussed care package was developed, including health services such as HIV/TB health education, HST and TB screening and linkage to care. Six events have been held in this school to date, covering 1200 participants, 435 of which received HCT, with eight students testing positive and being linked to antiretroviral treatment.  Over 8400 condoms were distributed.

Bending the Curves: Outreach Testing

Doctors Without Borders (MSF) Lay Counsellor Nkosinathi Mpungose delivers a HIV health talk to learners of Hhashi High School in ward 1 of Uthungulu District, Umlalzi Municipality Eshowe. The learners will be given the opportunity to sign up for HIV testing at the Mobile 1-Stop Shop (M1SS) parked on the school grounds. MSF’s Mobile 1-Stop Shop has travelled to dozens of schools, colleges and local sporting and cultural events to deliver HIV Counselling and Testing to people of all ages in rural KwaZulu-Natal, the South African province with the highest prevalence of HIV infection. Photographer:  Greg Lomas / Médecins Sans Frontières
Community Health Agent Babongile Luhlongwane delivers a HIV health talk to residents of a homestead in the rural Entumeni Umlalazi Municipality under Uthungulu District, KwaZulu-Natal, an area which has a high prevalence of HIV. She is one of almost 90 Community Health Agents managed by Medecins Sans Frontieres (MSF) to take testing and counselling the most remote parts of the province. Photographer: Greg Lomas / Médecins Sans Frontières
Community Health Agent Babongile Luhlongwane conducts an HIV test on Andile (28), who lives in the remote Entumeni District of KwaZulu-Natal, where HIV prevalence in South Africa is among the highest. If he tests positive, she will refer him to the nearest local clinic to be initiated onto ARVs. Babongile is one of nearly 90 dedicated health workers who are taking HIV counselling and testing to the most remote parts of KwaZulu-Natal. She says she enjoys teaching people how HIV works, and helping them to start on treatment if necessary. Photographer: Greg Lomas / Médecins Sans Frontières
Learners of Hhashi High School in the remote Umlalazi Municipality under Uthungulu Districtict in KwaZulu-Natal stand in line to receive HIV Counselling and Testing at Medecins Sans Frontieres (MSF) Mobile 1-Stop Shop. MSF uses the vehicle to deliver HIV Counselling and Testing to people of all ages in rural KwaZulu-Natal, the South African province with the highest prevalence of HIV infection. Photographer: Greg Lomas / Médecins Sans Frontières
Community Health Agent Babongile Luhlongwane conducts an HIV test on 23-year-old Philisiwe, a young woman living in the remote Entumeni District of KwaZulu-Natal, where HIV prevalence is at its highest. If found positive Philisiwe will be referred to the nearest local clinic to be initiated onto ARVs. Photographer: Greg Lomas / Médecins Sans Frontières
Learners of Hhashi High School in the remote Umlalazi Municipality under Uthungulu Districtict in KwaZulu-Natal stand in line to receive HIV Counselling and Testing at Medecins Sans Frontieres (MSF) Mobile 1-Stop Shop. MSF uses the vehicle to deliver HIV Counselling and Testing to people of all ages in rural KwaZulu-Natal, the South African province with the highest prevalence of HIV infection. Photographer: Greg Lomas / Médecins Sans Frontières
Twenty-six-year-old Londiwe, a young mother, gets her blood pressure taken by a Medecins Sans Frontieres (MSF) nurse at the Community Adherence Club she’s attending at King Dinizulu Clinic in Eshowe, KwaZulu-Natal. She is among 30 stable HIV+ patients who attend the club once every two months to have their health checked and receive their ARVs. This relieves people living with HIV of the hassle of sitting in long queues for 1-on-1 visits, and reduces the strain on an already overburdened public health system. Photographer: Greg Lomas / Médecins Sans Frontières
Community Care Giver Nonhlanhla Ngema passes a long queue of patients at Eshowe Gateway Clinic to pick up ARVs for members of her Community ART Group (CAG). Medecins Sans Frontieres (MSF) has been piloting CAGs as a model of care for stable HIV+ patients in rural districts of southern Africa, where HIV prevalence is at its highest. CAG members meet once every two months to review their health and arrange for collection of their ARVs without having to sit in long queues at clinics. Photographer: Greg Lomas / Médecins Sans Frontières
Community Care Giver Nonhlanhla Ngema delivers anti-retrovirals (ARVs) to Elizabeth, a member of her Community ART Group (CAG) in Sunnydale, Eshowe, KwaZulu-Natal. Medecins Sans Frontieres (MSF) has been piloting CAGs as a model of care for stable HIV+ patients in rural districts of southern Africa, where HIV prevalence is at its highest. CAG members meet once every two months to review their health and arrange for collection of their ARVs without having to sit in long queues at clinics. Photographer: Greg Lomas / Médecins Sans Frontières