School Health Nursing Programme for Adolescents Nadia Ahmed Desmond Tutu HIV Foundation INTEREST conference Kigali, Rwanda 2018
Background Adolescents need appropriate and accessible services. School health nurses exist, but are lacking in secondary schools. During this time issues around sexual and psychological health are more pressing as adolescents develop. Services are needed that do not take them out of the learning environment for longer than needed. The impact on health can be at a significant personal cost, lasting long into the future.
Background School is protective for adolescents in terms of HIV, pregnancy -----> without which the risk increases! (1) Limited data on similar programmes for secondary schools Data from New Zealand, UK, USA, Hong Kong (2,3) Integrated School Health Policy Department of Education SA (4) Nurses from primary health care Visit schools only once a year Insufficient staff, time limits, lack of equipment & environment, rural Exists but not translated into implementation 1) Mason-Jones AJ 1, Sinclair D, Mathews C, Kagee A, Hillman A, Lombard C. School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents. Cochrane Database Syst Rev. 2016 Nov 8;11:CD006417. 2) Buckley S 1, Gerring Z, Cumming J, Mason D, McDonald J, Churchward M School nursing in New Zealand: a study of services.. Policy Polit Nurs Pract. 2012 Feb;13(1):45-53. 3) Lee RL 1. The role of school nurses in delivering accessible health services for primary and secondary school students in Hong Kong. J Clin Nurs. 2011 Oct;20(19-20):2968-77. 4) www.education.gov.za
Aim To offer adolescent youth friendly services (AYFS) as a school health nursing programme in secondary schools in Cape Town, South Africa.
Materials & Methods The School Health Nursing Programme is part of a bigger project called The Zimele Project. Implemented by DTHF with the provincial and municipal department of health.
The Zimele Project A multi-pronged prevention social and health intervention programme for 20 000 adolescents: predominantly adolescent girls and young women aged 10-24 years, both in and out of school. Reduce New HIV Infections in girls and young women Keep girls in school until graduation Decrease teenage pregnancy incidence
The Zimele Project: geared towards those in their 2 nd decade of life Keeping Girls in School: Health Education in School In Addition: Child Protection Services & Soul Buddyz Parents In Addition: Rise Clubs & Community dialogues with men Adolescenttailored health services Soul Buddyz Clubs: In School In Addition: Rise Clubs, Teen Parenting & PrEP Women of Worth: Incentive & Care Programme Age 10 years 14 years 19 years 24 years Impact evaluation Service utilisation
Hub & Spokes Referral Model Hub: AYFS Clinic Spokes: Schools, Mobile Units, School Health RNs, WOW, TPP etc Model: Linking services to health facilities Health utilisation Operational Footprint: 50 Primary Schools 45 Secondary schools 24 Health facilities 10 Community Venues
Secondary Schools N=45
Health Facilities N=24
Materials & Methods Secondary schools in Klipfontein and Mitchell s Plain sub-district in Cape Town, South Africa were selected in collaboration with the provincial Department of Education. Schools were selected based on: location within the sub-district having females in Grades 8-12 student pregnancy data for the preceding three years.
ABC Package Stakeholder relationships developed with schools, and the school health nursing programme was offered. Permission for registered nurse to attend weekly to fortnightly offering a range of healthcare services to school learners. Package of service was offered, with contracts with school. Emergency advice available within school hours. Sr. Boneta Smitsdorff Mitchell s Plain Sr Phindile Matshini Philippi/ Crossroads Sr. Beulah Classen Athlone/ Hanover Park Sr. Mariam Gqiza Nyanga/ Gugulethu/ Manenberg
ABC Package
Results Service Package accepted by School 40/45 secondary schools gave permission. 143 students seen (Feb Mar 18). 75% female (n=107). 25% 33% 42% Median age 16 years (range 8-21). Package A Package B Package C
Results: HIV testing 49% (71/145) requested HIV tests. 8/36 males ALL were negative Most common risk factor was not knowing partner s status.
Results: Pregnancy testing 62% (66/107) requested pregnancy tests. 4 were positive 2 requested terminations 1 wanted to discuss the result with a parent 1 referred to antenatal services.
Results: Reasons for attendance 8% 1% 1% 4% 29% Sexual and reproductive health (STI, menstruation, MMC) Contraception (initiation, continuation, side effects, breakthrough bleeding) Other General wellness 35% 22% Abuse (emotional, sexual) Social issues Mental health (depression)
Results: Referrals 33% (12/36) males enquired about circumcisions. A total of 30% (44/145) referrals were required Local healthcare facilities (n=25), hospital (n=13), social worker (n=6).
Conclusions Early preliminary data set. Majority of students female; 51% requiring SRH needs. Referrals needed for approximately one third. Developing healthcare services within schools, brings healthcare direct to adolescents, enabling healthcare providers to reach them at a time and place more conducive to their daily life. Facilitating their needs Preventing them from missing school Furthering their education and future possibilities
Conclusions More on-site management (e.g. treatment of minor ailments) would facilitate adolescent healthcare by reducing need for referrals, thereby reducing the burden on current existing health services. Intervening early with preventative measures can facilitate promoting positive health and well being. Impact of education and linkage to health services is key. Dependent on referrals system within area (AYFS healthcare clinics, Peer Navigators, Social Workers).
Next Steps Multiple stakeholder involvement: Other schools Parents Feedback from learners, principals and local services, nurses Department of Health Department of Education. Continue to monitor. Implement in other areas. Community of practice champions forum.
Doc, they look at me and see hope! The learners at the schools are faced with lots of social issues. Each week I have at least one learner that is sexually abused by a family member. They face peer pressure every day. I think the learners just needed someone they can trust and can open up to. I really feel like I m making a difference in the lives of learners.
Acknowledgements Beulah Classen Boneta Smitsdorff Phindile Matshini Miriam Gqiza Colleen Herman Linda-Gail Bekker The Zimele Team Schools, Principals & School Learners Department of Health Department of Education