USAID SOUTH AFRICA SCHOOL-BASED SEXUALITY AND HIV PREVENTION EDUCATION ACTIVITY LINKAGES TO CARE FOR ADOLESCENT GIRLS AND YOUNG WOMEN LEARNERS DISCUSSION PAPER

This vulnerability is exacerbated by socio-cultural, economic, and biological factors. To address this issue, the Education Development Centre (EDC) has prioritized a school-based Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program to empower AGYW and link them to essential services. The DREAMS program aims to reduce teenage pregnancy levels in schools by providing AGYW with access to HIV testing, HIV prevention options, post-violence care, and voluntary comprehensive sexual and reproductive health services. A process evaluation was conducted to focus on learner linkages to services and provide recommendations to strengthen the linkages to care process. Semi-structured interviews were conducted with seven Learner Support Agents (LSAs), one DREAMS Linkages Manager (DLM), two DREAMS implementing partner representatives, and two school-based support team (SBST) members. The results of the evaluation revealed that the process of identifying vulnerable AGYW learners in schools was inconsistent across the six EDC implementation schools in Mpumalanga, Bohlabela education district, and Gauteng, Johannesburg West education district. Learner support agents play a crucial role in identifying, referring, and linking vulnerable learners to services, but they reported being ill-equipped to perform their expected roles in schools. The lack of youth-friendly services for vulnerable learners was identified as a barrier in the referral and linkages process, with AGYW learners often reporting fear of healthcare workers. The evaluation also highlighted the importance of training and capacitating learner support agents to ensure they can effectively perform their roles in schools. Ensuring clear communication and coordination between DREAMS partners that offer services to vulnerable learners is also crucial in referral pathways and layering services. The DREAMS program completion continuum emphasizes the need for a comprehensive approach to addressing the vulnerabilities of AGYW, including access to education, economic empowerment, and social support. The Department of Basic Education (DBE) reported that 130,000 babies were delivered by adolescent girls aged 10 to 19 in South African public health facilities in 2019, with this figure increasing to 136,386 deliveries for adolescent girls in the same age group in 2020. More recently, data from Gauteng Department of Health indicated that over 23,000 adolescent girls below the age of 18 years gave birth within the period of April 2020 and March 2021. The DREAMS program aims to address this issue by providing AGYW with the necessary support and services to reduce their vulnerability to HIV infection and unintended pregnancy. The DREAMS theory of change model emphasizes the importance of layering services to address the complex needs of AGYW. The model highlights the need for a comprehensive approach that includes education, economic empowerment, and social support to address the vulnerabilities of AGYW. The evaluation of the DREAMS program in South Africa has provided valuable insights into the challenges and opportunities for strengthening the linkages to care process. By addressing these challenges and opportunities, the DREAMS program can play a critical role in reducing teenage pregnancy levels in schools and improving the health and well-being of AGYW in South Africa.