School Health Nursing Programme

for Adolescents

Nadia AhmedDesmond Tutu HIV Foundation

INTEREST conferenceKigali, Rwanda 2018

• 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

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 AJ1, 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 S1, 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 RL1. 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.

Reduce New HIV Infections in girls and young women

Keep girls in school until graduation

Decrease teenage pregnancy incidence

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.

The Zimele Project: geared towards those in their 2nd decade of life

10 years 14 years 19 years 24 years

Age

Soul Buddyz Clubs: In School

Keeping Girls in School: Health Education in

School

Women of Worth: Incentive & Care

Programme

In Addition: Rise Clubs & Community

dialogues with men

In Addition: Rise Clubs, Teen

Parenting & PrEP

In Addition: Child Protection Services & Soul Buddyz Parents

Adolescent-tailored health

services

Impact evaluationService utilisation

✓ Operational Footprint:• 50 Primary Schools• 45 Secondary schools• 24 Health facilities• 10 Community Venues

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

Seco

nd

ary

Sch

oo

ls N

=45

He

alth

Fac

iliti

es

N=2

4

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. Beulah Classen

Athlone/ Hanover Park

Sr. Boneta Smitsdorff

Mitchell’s Plain

Sr Phindile Matshini

Philippi/ Crossroads

Sr. Mariam Gqiza

Nyanga/ Gugulethu/ Manenberg

ABC Package

Results

• 40/45 secondary schools gave permission.

• 143 students seen (Feb – Mar 18).

• 75% female (n=107).

• Median age 16 years (range 8-21).

42%

33%

25%

Service Package accepted by School

Package A Package B Package C

• 49% (71/145) requested HIV tests.• 8/36 males• ALL were negative• Most common risk factor was not knowing partner’s status.

Results: HIV 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: Pregnancy testing

29%

22%35%

8%

4%

1% 1%Sexual and reproductive health (STI,menstruation, MMC)

Contraception (initiation, continuation,side effects, breakthrough bleeding)

Other

General wellness

Abuse (emotional, sexual)

Social issues

Mental health (depression)

Results: Reasons for attendance

• 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).

Results: Referrals

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