APPENDIX 1
Memorandum submitted by Professor Roy
Williams, Education for Development
Note:
This paper is based in large part on sections
of a report by Debbie Gachuhi, UNICEF ESARO Consultant, November
1999. Some additions have been made with reference to South Africa.
The section on Pro-change and Education for Development has been
added in entirety, and is not part of the Gachuhi report.
The full Gachuhi report can be made available,
as can reports and articles on the Pro-change programme, work
that Education for Development personnel have done in Southern
Africa, and studies by the South African Council for Scientific
and Industrial Research and the Medical Research Council.
The HIV/AIDS pandemic continues to ravage the
Eastern and Southern Africa Region (ESAR). The statistics are
disturbing: at least 40 million people are infected with HIV in
sub-Saharan Africa. The bulk of new AIDS cases are among young
people, aged 15-25 and females are disproportionately affected.
The ability of girls and women to protect themselves from HIV
is constrained by their status in society.
Life expectancy in some countries has already
started on a downward spiral and is expected to drop to 30 years
or less in nine sub-Saharan countries by the year 2010. Figures
from the CSIR (Council for Scientific and Industrial Research)
in Johannesburg state that for a child born in Kwa-Zulu Natal
today, life expectancy is already down to 29 years. AIDS-related
mortality has begun to reverse all the gains made in health, education
and welfare over the past 20 years.
Children will be the most affected as a result
of HIV/AIDS as they live with sick relatives in households stressed
by the drain on their resources. They will be left emotionally
and physically vulnerable by the illness or death of one or both
parents. Subsequently, children who have lost one or both parents
are more likely to be removed from school, to stay home to care
for the sick and to be pulled into the informal economy to supplement
lost income. This is especially the case for girls.
The AIDS epidemic is beginning to have a serious
impact on the education sector, on demand, on supply, and on the
management and quality of education provided at all levels. As
a result of HIV/AIDS, there are relatively fewer children needing
education. Fewer children are being born because of the early
death of one or both parents. Moreover, fewer parents will want
to send their children to school, and there will be fewer families
who are able to afford to send their children to school. Fewer
students in the education system and lower demand for places in
education programmes, will most probably lead to a smaller supply
of facilities and places. Schools that have enrolments below a
certain minimum may therefore be closed and the remaining pupils
moved to other schools. Even if facilities continue to be available,
there may be a lack of teachers and other personnel to provide
teaching services. The quality of learning outcomes and education
will be affected by several confounding factors which will emerge
as the pandemic takes a deeper hold in the ESAR countries. Already,
education systems have begun to experience increased problems
of teacher absenteeism and loss of teachers, education officers,
inspectors, planning and management personnel. Regrettably, in
the ESAR region, the impact and devastation to the education system
has yet to be calculated or determined although several countries
have planned such studies.
The health system in many countries is already
being overloaded by AIDS and AIDS-related diseases. The infections
that have already occurred in countries such as South Africa
will cause at least one million AIDS deaths per annum in South
Africa from 2005, and the infection rates have not yet peaked:
in the Johannesburg region, one study has found that 50 per cent
of 20 year old women, and 60 per cent of 25 year old women are
infected. The figure for 25 year old women a year ago was 50 per
cent (CSIR).
When one combines these figures with the figure
of 50 per cent of pupils in Matric in South Africa (grade 12)
are 20 years old, and 25 per cent of them are 25 years old, it
is apparent that a large proportion of the pupils, especially
girls, will die while at school, or soon afterwards.
Education systems have an essential role to
play in reversing the very pandemic that threatens it. Young people,
especially those between five and 14 years, both in-school children
and out of school youth, offer a window of hope in stopping the
spread of HIV/AIDS if they have been reached by Life Skills Programmes.
In the absence of a cure, the best way to deal with HIV/AIDS is
through prevention by developing and/or changing behaviour and
values.
Life skills programmes aim to foster positive
behaviours across a range of psycho-social skills, and to change
behaviours learned early, which may translate into inappropriate
behaviour at a later stage of life. Life skills programmes are
one way of helping children and youth and their teachers to respond
to situations requiring decisions which may affect their lives.
Such skills are best learned through experiential activities which
are learner centred and designed to help young people gain information,
examine attitudes and practice skills. Therefore life skills education
programmes promote positive health choices, taking informed decisions,
practising healthy behaviours and recognising and avoiding risky
situations and behaviours. Research shows that these programmes
do not lead to more frequent sex or to an earlier onset of sexual
activities, as opponents fear. Nor do they lead young people to
promiscuity.
To date, there are too few life skills programmes
in ESAR that are targeting children and young people with information
about HIV/AIDS and that meet the criteria for minimally effective
education programmes. Many countries in the region are just beginning
to explore the concept of life skills and how to advocate for
it to be accepted and adopted into the education system.
In the UK, Pro-change has been working on behaviour
change/life-skills programmes for some years, targeting smoking
initially, and more recently AIDS and reproductive health, in
many Health Authorities in the UK. Pro-change and Education for
Development are in discussion with a number of agencies and organisations,
to see whether the Pro-change programme can be implemented in
South Africa, in Southern Africa, as well as in the Commonwealth.
The Pro-change programme is a thoroughly researched
and tested programme, and has the following advantages: It is
1. A population-wide approach.
2. Explicitly a behaviour change programme.
Information, strategies, support, suggestions and interaction
are all designed and compiled to meet behaviour change goals.
3. Based on an extensively researched analysis
of 15 years of behaviour change programmes.
4. A staged behaviour change approach. Taking
action to actually change a particular behaviour is only phase
four. Before that, there is important work to be done in communicating
with people who are not yet thinking about change, who have started
to think about changing, and who have started to plan how they
will change. The fifth stage is maintaining the change.
5. A differentiated message and communication
approach. Messages and interactions are customised for each of
the five stages in behaviour change.
6. An individualised programme. Each user
can be given customised information, and can be helped to develop
and implement their own change.
7. Related to well researched norms of behaviour
in the target community. This enables the user to compare her/his
progress with her/his peers.
8. Available in paper and CD-ROM versions,
with group work support.
9. Able to use the considerable benefits
of computer interaction: guaranteed confidentiality and privacy,
which is valuable when discussing sexual diseases and behaviour;
and individualised interaction, which allows for a highly responsive
programme, based on honest feedback.
10. Sustainable and efficient. It is implemented
over two years, but requires only about 10 sessions over that
period. In the computer version it can be implemented with only
one lap-top computer per school.
11. Based on developing the user's own resources
and strategies for change. It is a life skills programme, and
can also be used in similar format for a variety of other behaviours,
including smoking, drug use, eating behaviours etc. The life skills
learning is, in other words, transferable and generalisable.
12. Designed, researched, and implemented
in prevention and cessation programme. It has been tried and tested,
and subject to published research, in a variety of communities
in the USA and the UK, over many years.
Education for Development, a Reading-based charity
that has worked in development in the Commonwealth for 16 years,
and Pro-change are available to make further presentations, or
to supply further information on request.
Professor Ray Williams
Education for Development
May 2000
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