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Innovative Professional Development for Multisectoral Policy Making and Programming for Adolescent Wellbeing

2024; Elsevier BV; Volume: 74; Issue: 4 Linguagem: Inglês

10.1016/j.jadohealth.2023.12.025

1879-1972

Jayjay John Karumazondo, David A. Ross, Aveneni Mangombe, Linnet K. Zvoushe, Kelvin Jani, Debrain Mugarapanyama, Jacquiline T. Gumbo, Kwadzanai R.L. Nyanungo, Wenceslas Nyamayaro, Ellias Murinda, Marvellous Mhloyi, Rashida A. Ferrand, Constance Mackworth-Young,

Early Childhood Education and Development

The global movement to promote adolescent wellbeing is gathering momentum, with the development of a conceptual framework [[1]Ross D.A. Hinton R. Melles-Brewer M. et al.Adolescent well-being: A definition and conceptual framework.J Adolesc Health. 2020; 67: 472-476Google Scholar], global measurement indicators [[2]Guthold R. Moller A.B. Azzopardi P. et al.Commentary the global action for measurement of adolescent health (GAMA) initiative: Rethinking adolescent metrics.J Adolesc Health. 2019; 64: 697-699Google Scholar], the 1.8 Billion Young People for Change Campaign and the Global Forum for Adolescents in 2023 [[3]I.8 Billion young people for change: Global Forum for adolescents `23.https://www.1point8b.org/global-forum-for-adolescentsDate accessed: June 21, 2023Google Scholar]. The United Nations H6+ Technical Working Group on Adolescent Health and Wellbeing have defined adolescent wellbeing as "adolescents have the support, confidence, and resources to thrive in contexts of secure and healthy relationships, realizing their full potential and rights" [[1]Ross D.A. Hinton R. Melles-Brewer M. et al.Adolescent well-being: A definition and conceptual framework.J Adolesc Health. 2020; 67: 472-476Google Scholar]. Countries around the globe, including Zimbabwe, have signed commitments for national action on adolescent wellbeing. To achieve national-level improvements in adolescent wellbeing, strategies to inspire and promote multisectoral change are needed. But multisectoral programming for adolescent wellbeing remains a major challenge due to historically siloed structures, insufficient resources, a lack of political will, divergent institutional cultures, poor communication between sectors, and the inability to attribute benefits of multisectoral programming to an individual sector [4Efevbera Y. Haj-Ahmed J. Lai J. et al.Multisectoral programming for adolescent health and well-being in Sub-Saharan Africa—Insights from a symposium hosted by UNICEF and the Bill & Melinda gates foundation.J Adolesc Health. 2020; 67: 24-25Google Scholar, 5Ward J. Multisectoral and Intersectoral Action for Improved Health and Well-Being for All: Mapping of the WHO European Region Final Report. 2018https://www.childrenandaids.org/sites/default/files/2018-11/Multisectoral%20and%20intersectoral%20action%20for%20improved%20health%20and%20well-being%20for%20all%20-%20Mapping%20of%20the%20WHO%20European%20Region.pdfDate accessed: January 12, 2024Google Scholar, 6Kuruvilla S. Hinton R. Boerma T. et al.Business not as usual: How multisectoral collaboration can promote transformative change for health and sustainable development.BMJ. 2018; 363k4771Google Scholar, 7Rasanathan K. Bennett S. Atkins V. et al.Governing multisectoral action for health in low- and middle-income countries.PLoS Med. 2017; 14e1002285Google Scholar]. Rare examples of multisectoral adolescent programming include the Adolescent Girls Initiative in Kenya [[8]Adolescent Girls Initiative-Kenya – Population Council.https://popcouncil.org/project/adolescent-girls-initiative-kenya/Date: 2022Date accessed: July 30, 2023Google Scholar], the Geração Biz in Mozambique [[9]Chandra-Mouli V. Gibbs S. Badiani R. et al.Programa Geração Biz, Mozambique: How did this adolescent health initiative grow from a pilot to a national programme, and what did it achieve?.Reprod Health. 2015; 12: 12Google Scholar], and the Zomba cash transfer study in Malawi [[4]Efevbera Y. Haj-Ahmed J. Lai J. et al.Multisectoral programming for adolescent health and well-being in Sub-Saharan Africa—Insights from a symposium hosted by UNICEF and the Bill & Melinda gates foundation.J Adolesc Health. 2020; 67: 24-25Google Scholar], where program successes can be attributed to shared interests of the stakeholders and open communication between them [[4]Efevbera Y. Haj-Ahmed J. Lai J. et al.Multisectoral programming for adolescent health and well-being in Sub-Saharan Africa—Insights from a symposium hosted by UNICEF and the Bill & Melinda gates foundation.J Adolesc Health. 2020; 67: 24-25Google Scholar]. Capacity strengthening is key to effective and evidence-informed policy making and programming, particularly if multisectoral coordination is to be achieved [[10]OECDBuilding Capacity for evidence-informed policy-making: Lessons from Country experiences. OECD, Paris2020Google Scholar]. Despite the increasing focus on adolescent wellbeing, a search of the published literature did not reveal descriptions of any previous professional development programs to support policy makers and program managers to design and implement policy and programs to improve adolescent wellbeing. To begin to fill this gap, we share the design, and experiences from a novel program, EMPOWA-Zim: EMpowering PrOfessionals for the Wellbeing of Adolescents Programme in Zimbabwe. EMPOWA-Zim is a multisectoral professional development program for senior and mid-level policy makers and program managers working with adolescents in Zimbabwe. It aims to build skills and multisectoral collaborations across ministries and government agencies, nongovernmental organizations, and networks of youth advocates to strengthen the effectiveness of policy making and programming for the wellbeing of adolescents. This commentary is intended to provide an example of the type of programs that will likely be needed to support implementation of effective strategies to promote global adolescent wellbeing [1Ross D.A. Hinton R. Melles-Brewer M. et al.Adolescent well-being: A definition and conceptual framework.J Adolesc Health. 2020; 67: 472-476Google Scholar, 2Guthold R. Moller A.B. Azzopardi P. et al.Commentary the global action for measurement of adolescent health (GAMA) initiative: Rethinking adolescent metrics.J Adolesc Health. 2019; 64: 697-699Google Scholar, 3I.8 Billion young people for change: Global Forum for adolescents `23.https://www.1point8b.org/global-forum-for-adolescentsDate accessed: June 21, 2023Google Scholar]. The EMPOWA-Zim Programme was designed and delivered by a partnership of University of Zimbabwe (UZ), the London School of Hygiene and Tropical Medicine (LSHTM), and the Biomedical Research and Training Institute (BRTI). The core teaching staff was composed of four experienced teachers from the partnership organizations, each paired with a youth facilitator. Program design and delivery was supported by an Advisory Group, who met quarterly and was chaired by the Ministry of Health and Child Care and the Ministry of Primary and Secondary Education and composed of key stakeholders from multisectoral partner organizations. The program spanned 15 months, including two spaced-apart in-person teaching weeks, and 12 months supported "change projects" that each participant designed and delivered to initiate a policy or program change for the improvement of adolescent wellbeing, embedded within their organization. To date, two cohorts of participants have participated in the EMPOWA-Zim Programme. Participants were first nominated by their respective organization, applied by submitting an application form with a letter of support from their institution, and were scored and selected by the program teaching body. Applications were scored, based on the applicant's qualifications, experience, support from their supervisor, relevance of the program to their job, motivation to participate in the program, and the quality and relevance of their proposed change project. In total, 22 and 24 professionals, respectively, were invited to participate in the two programs. Six and three individuals, respectively, were not able to join the two programs due to competing workshops or illness. 14/16 and 20/21 of the remaining participants from the first and second intake, respectively, remained actively engaged throughout the program. Participants were mid-to senior level policy makers and program managers from government ministries, parastatals and nongovernmental organizations (Table 1).Table 1Participants in cohort 1 and 2: organizations, roles, and change projectsOrganizationRoleChange project titleCohort 1 Change Projects Ministry of Health and Child CareActing Provincial Maternal and Child Health, HIV and tuberculosis OfficerCommunity-led approach toward reducing adolescent pregnancies in Shamva District Ministry of Health and Child CareSenior National Monitoring and Evaluation OfficerRevised age and sex disaggregation of routine data in the health management information system Ministry of Primary and Secondary EducationGuidance and Counseling OfficerImproving counseling and life skills education in primary and secondary schools. Ministry of Primary and Secondary EducationDistrict Schools InspectorDeveloping strategies to increase the uptake of technical and vocational learning areas by adolescents Ministry of Primary and Secondary EducationDeputy Director Psychological ServicesEnforcing psychological interventions in achieving positive learner conduct in Goromonzi District Ministry of Primary and Secondary EducationActing Principal Education PsychologistDevelopment of guidance on the prevention and management of bullying in Bulawayo schools Ministry of Women Affairs, Community, Small and Medium Enterprises DevelopmentGender OfficerReducing gender-based violence by promoting access to sexual and reproductive health and rights information and services to adolescent girls in Epworth, Harare. Ministry of Youth, Sport, Arts and RecreationAdministrative OfficerReducing substance and drug abuse among young people in Chitungwiza District. National AIDS CouncilNational Youth CoordinatorMoving from commitment to action in the national response to sexual and reproductive health, HIV and AIDS for young people with disabilities in Zimbabwe Plan InternationalSexual and Reproductive Health Project ManagerImproving access to sexual and reproductive health and sexual gender-based violence information and services among pregnant and teenagers mothers in Epworth District Students And Youth Working on Reproductive Health Action TeamDeputy DirectorEstablishing functional child protection policies and procedures for the students and youth working on reproductive health action team Young People's Network on Sexual & Reproductive Health, HIV & AIDSNational FacilitatorBridging the sexual and reproductive health information and services gap among adolescents living in the streets of Harare Young People's Network on Sexual & Reproductive Health, HIV & AIDSProvincial Facilitator"#I HAVE Rights too": Promoting access and uptake of sexual and reproductive health and gender-based violence information and services for adolescents with disability in Harare Zimbabwe National Council for the Welfare of ChildrenNational DirectorAdvocacy for adolescent wellbeingCohort 2 Change projects Adult Rape ClinicDirectorIncreasing uptake of sexual and gender-based violence services by adolescent survivors in Mbare district, Harare. Education Coalition of ZimbabweSexual and Reproductive Health Project OfficerImproving sexual and reproductive health for adolescent students with disability in higher and tertiary institutions National AIDS CouncilProvincial Monitoring and Evaluation OfficerEnhancing menstrual health and hygiene program monitoring, evaluation and reporting in Epworth, Harare Ministry of Health and Child CareProvincial Health Promotions OfficerImproving adolescents sexual and reproductive health service quality and uptake by adolescents Ministry of Health and Child CareProvincial Health Promotions OfficerStrengthening the accessibility of sexual and reproductive health services for young people living on the streets of Gweru Ministry of Higher and Tertiary Education, Science and Technology DevelopmentPrincipalEmpowerment of disadvantaged adolescents in Gweru through skills development Ministry of Primary and Secondary EducationSchools InspectorEnhancing quality delivery of guidance and counseling and life skills orientation programs in Masvingo Province Ministry of Primary and Secondary EducationEducation Research OfficerToward a model of increasing access to education for pregnant girls to return to school in Mashonaland East Province Ministry of Primary and Secondary EducationSchools InspectorEnforcing positive disciplining by teachers on pupils in Mashonaland East Province Ministry of Women Affairs, Community, Small and Medium Enterprises DevelopmentDeputy DirectorAdolescents' inclusivity in community development programs Ministry of Women Affairs, Community, Small and Medium Enterprises DevelopmentMonitoring and Evaluation OfficerInclusivity of adolescents in data collection and communication in monitoring and evaluation processes Ministry of Youth, Sport, Arts and Recreation, Sport, and RecreationSports and Recreation OfficerPromoting sport and recreation amongst adolescents in Rusape, Makoni District Ministry of Youth, Sport, Arts and RecreationActing DirectorAdolescent Mentorship Programme – offering life skills training to school drop out adolescents who are in small businesses Ministry of Youth, Sport, Arts and RecreationProvincial Arts and Culture OfficerCapacity building musicians to influence music content in the fight against drug and substance abuse by youth in Masvingo City Young People's Network on Sexual and Reproductive Health HIV/AIDSProvincial FacilitatorIntegrating mental health and Sexual Gender-Based Violence programming Young People's Network on Sexual & Reproductive Health, HIV & AIDSProvincial FacilitatorEnhancing the reporting of sexual harassment cases in tertiary institutions Zimbabwe National Family Planning CouncilYouth FacilitatorEngaging adolescents with physical and visual impairment in sexual and reproductive health and rights Zimbabwe Youth CouncilResearch and Documentation OfficerBuilding bridges for the child parliamentarians to accelerate adolescents health and wellbeing Zimbabwe Youth CouncilMonitoring, Evaluation, Accountability and Learning OfficerCombating gangsterism through conflict transformation among in school pupils in Harare ZvandiriRegional CoordinatorImproved disclosure among adolescents and young people living with HIV in eight districts in Zimbabwe Open table in a new tab The EMPOWA-Zim Programme involved five stages (Figure 1). Firstly, the participants were asked to read key documents on the adolescent wellbeing framework and the Zimbabwe National Youth Policy [[1]Ross D.A. Hinton R. Melles-Brewer M. et al.Adolescent well-being: A definition and conceptual framework.J Adolesc Health. 2020; 67: 472-476Google Scholar,[11]Zimbabwe National Youth PolicyNational youth policy.http://www.unesco.org/education/edurights/media/docs/6a282ededb1a68dc109f7cf4a91e488f87f833ed.pdfDate: 2013Date accessed: May 19, 2021Google Scholar], and submit a brief essay comparing the two (Stage 1). Stage 2 was an in-person teaching week, with each of the five days having a different focal topic (Figure 2). Each day had interactive learning sessions in the mornings and practical application of that learning to each participant's change project in the afternoon (Figure 2). For the work on their change projects, participants were split into four tutorial groups of four to six participants, with two tutors, one more experienced tutor, and one youth tutor from the teaching body. Participants went back to their organizations for three or four weeks during Stage 3 to reconfirm organizational buy-in for the change project, with one online tutorial conducted with each of the four tutorial groups. Stage 4 was a second in-person teaching week, with each of the five days having a different focal topic and a similar teaching structure to the first week. Finally, participants implemented their change projects over 12 months, supported by five online or telephone tutorials in their tutorial group.Figure 2Agendas for in-person teaching weeks.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The objective of these change projects was for participants to initiate an organizational improvement in policy and/or programming to promote adolescent wellbeing, embedded within the participant's existing role and their organization's scope of work. The change projects (Table 1) aimed to achieve concrete results within 12 months, without additional budget. Each participant wrote an initial idea for their change project in their application, with written support from their supervisor in their organizations, which they then refined during the two teaching weeks, and implemented over 12 months, with advice from their pair of tutors. Change projects provided participants with an opportunity to apply the learning that they had received during the teaching weeks of the program and the tutorials, and to build their skills and multisectoral collaborations. Additionally, the aim was to achieve a sustained change in the programming and/or policies for the improvement of adolescent wellbeing, through leveraging participants' influential positions across diverse sectors. Successful participants received a Certificate of Competence awarded jointly by UZ, LSHTM and BRTI. To receive certification, participants were required to have engaged in the EMPOWA-Zim Programme throughout, including submitting assignments of sufficient quality, and attending the teaching weeks and online tutorials. The submitted assignments include: 1) assignment on concepts of adolescent wellbeing linked to the pre-reading before the first teaching week; 2) draft change project proposal at the end of the first teaching week; 3) final two-page change project proposal at the end of the second teaching week; 4) brief written progress reports before each tutorial; 5) a final five-page report on the change project at the end of the program, including rationale, aims, objectives, implementation, modifications, achievements, lessons learned, and next steps. The 16 and 20 participants who participated actively throughout the first and second programs, respectively, each successfully designed and implemented their change projects and submitted their change project reports. Participants provided feedback on the EMPOWA-Zim Program through 1) writing feedback related to each of the day's sessions on sticky notes which they pasted anonymously on a feedback chart, 2) two "participant ears" volunteered each day to receive feedback from participants and pass that on anonymously to the program teaching body at the start of the next day's session; and 3) completing an anonymous paper-based evaluation questionnaire (completed by 11 and 20 participants who were present on the last in-person teaching day in the first and second program, respectively). In the evaluation questionnaire, 10 aspects of the program were rated on a four-point Likert scale: content, quality of the teaching, teaching methods, participant engagement, interaction with other participants, facilitation, organization and communication, venue, usefulness of the time for reflection at the end of each day, and fulfillment of expectations, with options for rating them as excellent, good, poor, or very poor. In both the first and second program, all 10 aspects were rated excellent or good by everyone. 100% of cohort one participants and 85% of cohort two participants said that they would recommend the EMPOWA-Zim Programme to colleagues. Within the evaluation form, each participant was invited to state what they thought were the three best things about the program and those that they thought needed change or improvement. Frequently mentioned positive points included: communication between the program organizers and participants; practical and engaging delivery and teaching methods; engagement of knowledgeable experts; equipping participants with skills to implement change that was linked with national priorities; change projects being practical and linked to participants' scope of work; multisectoral networking and collaboration; meaningful engagement and empowerment of adolescents and young people in the program; and the support from tutors. Points participants thought needed change or improvement included: more in-person weeks for teaching, including more time for complex topics; providing funding for change projects; providing accommodation for all participants (not just those from outside Harare) during the teaching weeks to ensure undistracted engagement in the program; engaging younger adolescents; and improving some aspects of the venue. Participants were also invited to submit written comments on the program. All the comments were positive and included:•"The opportunity to participate in this program is the best thing that has ever happened to me. It has provided my ministry the opportunity to deal with an issue which has been a problem for so long."•"The program is interactive and gives us time to draft strategies to fully incorporate adolescent wellbeing into our daily programming."•"I am confident that this will change my thinking and planning." The EMPOWA-Zim Programme is an innovative strategy to strengthen capacity among policy makers and program managers to work toward multisectoral changes for adolescent wellbeing. Two programs have been successfully delivered, with good participant retention, professional growth, and multisectoral collaboration among participants, and strong support from the five Zimbabwean Government Ministries that span the main sectors of adolescent wellbeing. It shows promise as a program to build capacity for policy makers and program managers, and to deliver policy and program shifts to improve adolescent wellbeing through the change projects. Key learnings from the program were:1.The value of practical and participatory teaching, particularly the change projects that were integrated into participants' jobs and aimed to effect sustained changes within their organizations.2.Facilitation of multisectoral collaboration, given the multisectoral nature of adolescent wellbeing, through inclusion and networking between participants and teachers from multiple sectors.3.The value of including both youth and more experienced facilitators as program organizers throughout the program's design and implementation.4.The importance of ensuring that the ideas for the "change projects" had the written support of the participant's organization's senior management and line manager from the start.5.The value of providing multiple ways for participants to provide timely, anonymous feedback on the program, allowing the organizers to address any concerns and to modify the program in real time.6.The respect afforded to the program by participants and their organizations related to the receipt of a "Certificate of Competence" issued to successful participants by the three organizing institutions (UZ, LSHTM, and BRTI). Limitations included challenges in obtaining buy-in from some government ministries (e.g. justice and social welfare) compared to others where buy-in was easier (e.g. health, education, youth and women's affairs). This was partly due to where existing connections with the organizing institutions lay, but also the perceived relevance of adolescent wellbeing within some of the ministries. Commitment to the 15-month program (rather than a short course) was also a challenge, particularly for more senior policy makers, and when participants changed jobs during the program. Lastly, several participants noted the challenge of delivering their change projects without additional funding. While the program providing funding for change projects may have resulted in more ambitious projects, implementing the change project within existing resources demonstrated organizational buy-in and may well have increased their sustainability, as well as reducing the administrative and financial burden on the program. The EMPOWA-Zim Programme demonstrates a promising strategy for strengthening capacity and multisectoral collaborations to promote national policing and programming for adolescent wellbeing. Such a model, and similar efforts will be needed across the globe to deliver the commitments made by the United Nations and countries for global and national action on adolescent wellbeing. Next steps include plans to make EMPOWA-Zim an annual Zimbabwe training program, to evaluate the program's impact, establish a multisectoral EMPOWA-Zim alumni network, and develop an open access toolkit to support other countries to set up a similar professional development program. The continuation and expansion of the EMPOWA-Zim Programme will strengthen capacity to promote impactful multisectoral policy making and programming to promote adolescent wellbeing, a current central global policy focus [[12]Mohan A. Kostelecky S.M. Sivakumar A. et al.Improving adolescent wellbeing is an urgent global priority.BMJ. 2022; 379o2511Google Scholar]. We would like to thank the EMPOWA-Zim Advisory Group for providing expert guidance on the design and delivery of the program. Thank you also to the University of Zimbabwe for hosting the in-person teaching weeks of the program. Thank you to Tino Mavimba, from Ardent Creative for her design of the figures. The program was funded by Viiv Healthcare.