Scaling up sexuality education in Nigeria: From national policy to nationwide application

Abstract

Comprehensive sexuality education (CSE) is recommended for universal coverage as an effective tool to reduce unwanted pregnancies, maternal mortality and transmission of sexually transmitted infections including HIV and to increase. Nigeria is one of few countries that have translated national policies on school-based CSE into near-nationwide implementation. Using the World Health Organization-ExpandNet framework, which provides a systematic structure for planning and managing the scaling up of health innovations, we examine how Nigeria's nationwide program was designed and executed. Crucial attributes that facilitated the scaling up included: technical consensus about the innovation and clarity about its components, dissection of a complex intervention into manageable components for implementation by organizations with complementary expertise, strong political leadership and championship in concert with advocacy and technical support from non-governmental organizations, proactive and energetic involvement of community stakeholders, effective program management to ensure adequate educational materials, and supervision and support. While initially insufficient, improvements were made to the information management system to ensure on-track implementation and mid-course corrections and to keep all the stakeholders, including funders, informed and engaged. Challenges included resistance to sexuality education, competing priorities for available human resources, and a lack of predictable and adequate funding for installing and sustaining a rapid scale up effort. Following the adoption of a national policy in 2002, Nigeria developed a well thought through strategy to scale up school-based CSE. Despite some weakness, implementation has largely proceeded according to plan. Nigeria's achievements and lessons learned are pertinent because, even in countries with national sexuality education policies, implementation remains patchy for the most part, especially in resource-limited settings.