This document reports on the results of a 2011 six-country study on the cost and cost-effectiveness of sexuality education programmes. It is the third major output of the United Nations Educational, Scientific and Cultural Organization (UNESCO) programme of work on sexuality education. The study intends to give an economic basis to the argument that sexuality education provides a key platform for HIV prevention amongst young people through investing in school-based sexuality education programmes, particularly in those countries most affected by the epidemic.
"The objective was to develop tools for measuring the cost and cost-effectiveness of HIV prevention programmes and to determine the cost of scaling up good quality HIV and sexuality education in schools. The cost-effectiveness component also measured the projected impact these programmes can have on reducing rates of HIV infection, other STIs [sexually transmitted infections] and unintended pregnancy. Where data were available, findings from the cost and cost-effectiveness exercises were expected to provide country-specific data on the following:
- Annual cost of quality sexuality education per learner and per hour of instruction (Estonia, India, Indonesia, Kenya, Nigeria and the Netherlands);
- And the cost-effectiveness of quality sexuality education as measured by the averted cost per case of HIV, STI and pregnancy reduced by implementing quality sexuality education (Estonia and Kenya)."
Country selection was based on a range of criteria, including the quality and scale of the sexuality education programmes, the type of HIV epidemic, and other regional and contextual factors. Also, where possible, the focus was on government-implemented programmes (Estonia, India, the Netherlands and Nigeria), rather than small-scale pilot programmes (Kenya and Indonesia).
"On the basis of the analysis in Estonia, evidence suggests that comprehensive sexuality education programmes are potentially highly effective, cost-effective and even cost-saving. However, the findings suggest that these outcomes are dependent on context and certain programme characteristics, namely, that they are intra-curricular, comprehensive, nationally rolled out and delivered in conjunction with youth friendly health services. A comprehensive sexuality education programme, optimally implemented, may therefore compare favourably to other preventive interventions for HIV, such as voluntary counselling and testing, or condom social marketing, which typically incur costs to achieve health effects, as repeatedly shown in international literature....The evaluation of the sexuality education programme in Kenya did not identify any health impact. This may be related to methodological difficulties of measuring (changes in) sexual behaviour in a context where sexuality is a highly sensitive issue and acknowledgement of sexual practice may be punished; alternatively, it may be due to the programme design or implementation."
Key characteristics of programmes with potential to lead to improved health outcomes, as stated here, include:
- Building block paedagogical approach over several years
- Integrating into the curriculum
- Scaling up in schools and rolled out nationally
- Coupling comprehensive sexuality education with youth-friendly sexual and reproductive health (SRH) services - A combination of school-based education delivered in conjunction with health services (national and local) appears to be particularly effective. School-based programmes can leverage expertise and share resources with the health sector whilst delivering complementary messages and encouraging uptake of health services.
In addition, as stated in the report, “sexuality education is often a sensitive issue, requiring careful planning and a wide variety of advocacy and public education activities to achieve its implementation - depending on a country’s social and cultural context. Advocacy is a significant component of the costs of sexuality education programmes in all countries concerned.”
UNESCO website, September 26 2011.