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Addis Ababa University Faculty of Medicine ADDIS ABABA UNIVERSITY FACULTY OF MEDICINE DEPARTEMENT OF COMMUNITY HEALTH PROCESS EVALUATION OF THE QUALITY OF SERVICES GIVEN BY THE PROGRAM OF SECONDARY SCHOOL ANTI-AIDS CLUBS IN SOUTH WEST SHOA ZONE By Mengistu Kenea (BSc) THESIS SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES ADDIS ABABA UNIVERSITY IN PARTIAL FULFILLMENT OF THE REQUIREMENT OF THE DEGREE OF MASTERS OF PUBLIC HEALTH MARCH 2006 ADDIS ABABA,ETHIOPIA ADDIS ABABA UNIVERSITY SCHOOL OF GRADUET TUDIES PROCESS EVALUATION OF THE QUALITY OF SERVICES GIVEN BY THE PROGRAM OF SECONDARY SCHOOL ANTI-AIDS CLUBS IN SOUTH WEST SHOA ZONE By Mengistu Kenea (BSc) THESIS SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES ADDIS ABABA UNIVERSITY IN PARTIAL FULFILLMENT OF THE REQUIREMENT OF THE DEGREE OF MASTERS OF PUBLIC HEALTH Advisor Fikre Enquosellasse MARCH 2006 ADDIS ABABA,ETHIOPIA Acknowledgements First and for most I would like to owe my hearty appreciations to my instructor and advisor Fikre Enquoselassie for his unreserved comments and supports from the initiation to the end of this research. I would also like to extend my gratefulness to my instructor, Damen Hailemariam (Ph.D.), for his concern to support me with the necessary documents that I used in the development of the research proposal. The Ministry of education who found and supplied me with national intervention guide lines for the implementation of extra curricular activities and a manual (hand book) for the implementation of HIV-AIDS activities in schools. I feel very happy to use this special opportunity to uncover the maternal love that Mrs. Ulla Heimo and her families have had for me for many years starting from my elementary stage of education; and who at current has helped me to cover the overall living and education expenses during my work on my Masters degree in Public Health. Last but not least, I would like to extend my thanks to Ato Temesgen Bush for his being at the side of me during the whole process of my work on the research. i Table of Contents Contents Pages Acknowledgements………………………………………………..I Table of contents…………………………………………………..II List of Tables………………………………………………………..IV List of figures……………………………………………………….V List of abbreviations..…………………………………………….Vi Executive summary……………………………………………….VII 1.0. Introduction …………………. …………………………….1 1.1. Back ground…………………………………………………1 1.2. Statement of the problem………………………………….3 2.0 Literature Review …………………………………………….5 3.0 Objectives ……………………………………………………..12 3.1. General Objective…………………………………….12 3.2. Specific Objectives………………………………….12 4.0. Methods and Materials…………….……………………..13 4.1 Study area……………………………………………..13 4.2 Study Design………………………………………….14 4.3 Study Population…………………………………….15 4.4 Sample Size determination………………………..15 4.5 Sampling procedure…………………………………16 4.6. Data Collection………………………………………18 4.7. Data quality control………………………………..19 4.8. Data processing and analysis methods ……….20 4.9. Variables and definitions………………………….20 4.10. Qualitative survey Methods…………………….22 4.11. Ethical considerations………….… ……….…..25 ii 5.0 Results………………….……………………………………….27 5.1. Socio-demographic characteristics of respondents…..27 5.2. Participation level by students…………………………….28 5.3. Educators and the health education methods used….31 5.4. Results from FDGs and in-depth interviews …………..33 5.5. Reported knowledge and commitment of peer educators…38 5.6. Supports given to the anti-AIDS club by its stakeholders..40 5.7. Stakeholders Involvement (qualitative result)……………..42 5.8. Assessment of overall activity status of the club………….44 5.9. Constraints of the anti-AIDS clubs in the study area……47 6.0 Discussions………………………………………………………...50 7.0 Strengths and limitations of the study………………….......56 8.0 Conclusions and recommendations …………….……………57 9.0 References ………………………………………………………59 10. Annexes ………………………………………………………......63 iii List of Tables Tables Pages Table 1: Socio-demographic characteristics of the participants….27 Table 2: Distribution of the level and areas of students’ participation in the activities of the anti-AIDS club…………………….30 Table 3: Distribution of the teaching methods used by secondary School anti-AIDS clubs……………………………………32 Table 4: Participants opinion on the competence and commitment Of peer educators in teaching on HIV/AIDS………………39 Table 5: Distribution of supports given by stakeholders…………41 Table 6: Table of logistic regression model………………………….46 iv List of Figures Figures Pages Figure 1: Sampling Framework…………………………………17 Figure 2: Conceptual framework of the study………………63 v List of abbreviations AACs Anti- AIDS Clubs AAU Addis Ababa University AIDS Acquired Immune-Deficiency Syndrome DCH Department of Community Health EFA Education For All FGD Focus Group Discussion FM Faculty of Medicine HAPCO HIV/AIDS Prevention and Control Office HF Health Facility HIV Human Immune-Deficiency Virus IEC Information, Education Communication KII Key Informant Interview MDGs Millennium Development Goals M&E Monitoring and Evaluation MOE Ministry of Education MOH Ministry of Health MPH Master of Public Health PLWHA People living with HIV/AIDS UNESCO United Nations’ Educational Scientific and Cultural Organization WHO World Health Organization vi Executive summary Back ground- HIV/AIDS prevention strategy that focuses on school youth has a two fold importance. First, they can easily learn how to raise awareness about HIV/AIDS among their fellow students in an effective way. Second, they learn how to take the same massage in to their local community and thereby multiply the people to people efforts. Objectives-The objective of this study was to assess level of quality of services given by high school anti-AIDS clubs in south West Shoa Zone based on the status of the program inputs, program outputs and on the level of involvement by stakeholders of the program. Methods –A cross-sectional study was employed from November 2005 to January 2006. Data was collected from ten high school students, teachers and heads of stakeholder institutions. Self-administered questionnaire survey, focus group discussions and in-depth interviews were used for data collection. Students were selected from sections of ten high schools by probability sampling proportion to size. Individuals for the qualitative study were selected on purposive basis. Trained facilitators, supervisors, and note takers were used in data collection. Quantitative data was analyzed using SPSS Version 11 statistical package. Descriptive statistics and associations between variables were assessed by using chi- squares, p-values, Odds Ratios, and 95%CIs. Qualitative data was transcribed, translated, coded, classified segment by segment, categories and themes were developed to answer the research questions. Results- 333 (78.9%) of the participants reported that they participated in the activities of the club, and 77.9% of them reported that services given by the club was adequate. Students’ participation and level of services given was significantly high in schools where school directors and teachers gave support for the anti-AIDS club (p< 0.001) and when forum of vii discussion on HIV/AIDS exists among students (p<0.001). Students’ participation was high where parents were aware of the presence of anti-AIDS clubs in schools (p< 0.001). Frequent use of posters and reminders on HIV/AIDS was significantly associated with the services given and student participation level (p<0.001). Level of services given was also significantly associated with presence of counseling services in schools (OR=3.35, 95%CI= [1.99, 5.61]). Limited participation by stakeholders, absence of financial support and training for peer educators and teachers were major problems of the club. Conclusion and recommendations- This study addressed that the majority of secondary school anti-AIDS clubs in the study area are rendering adequate level of services, as reported by study participants, to create awareness among the school youth population. The program needs to get consistent financial support, supervision, training for peer educators and club advisors from its stakeholders. Similar studies are recommended to generate more in-depth information on secondary school anti-AIDS clubs viii 1.0 Introduction 1.1. Background HIV/AIDS Pandemic continues to spread around the world; and it is estimated that by 2010, five countries of strategic importance to the United States –Nigeria, Ethiopia, Russia, India, and China will collectively have the largest number of HIV/AIDS cases on earth. [1]. These countries, which comprise over 40% of the world’s population, are in the early –to- mid stages of the epidemic. According to this report adult HIV/AIDS prevalence in Ethiopia is the highest among the five countries indicating that –like Nigeria the disease has moved significantly in to the general population [2]. Among the officially reported AIDS cases in Ethiopia, about 69% are between the ages of 20 and 39 years [3]. Because HIV has a long asymptomatic incubation period, one would assume that most AIDS patients were infected during adolescence or early adulthood. Given that young people under the age of 25 represent more than half of the country’s population [4], a comprehensive HIV/AIDS prevention is needed for the youth. As part of the world wide effort, attempts have been made nationally in Ethiopia to reach both in-school and out of school youth in the country. AIDS/STD education program in senior secondary schools was started in 1992 and the Educational programs Supervision Department of the Ministry of Education was responsible for the program. The strategy
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