Strategies to facilitate safe sexual practices in adolescents through integrated health systems in selected districts of Zimbabwe

Abstract

Background: Zimbabwe has the highest teenage pregnancy rate in Sub-Saharan Africa. Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome prevalence in adolescents that are from tribes that perform cultural initiations and subscribe to certain norms are higher than the national prevalence, which is estimated at 12% (18% and 13.6% respectively) in Zimbabwe. Indigenous Health Systems and Modern Health Systems in Zimbabwe run parallel, thereby introducing challenges in managing adolescent sexual health due to conflicts. Aim: This study sought to develop strategies to facilitate the integration of Indigenous Health Systems and Modern Health System in Mberengwa and Umguza districts. The specific objectives were to: Explore Indigenous Knowledge that influences sexual experiences of adolescents; Assess the role played by different stakeholders in communities that influence adolescent development and sexual experiences; Establish the extent of influence of Indigenous Health Systems and Modern Health Systems on adolescent sexual behaviours; Develop strategies that leverage on empirical evidence to enhance Health Systems performance regarding the management of adolescent sexual issues, and to Validate the developed strategies. Methods: This research was conducted in two phases. The first phase utilised a concurrent triangulation mixed methods design with both qualitative and quantitative approaches. The findings from the qualitative and quantitative approaches were merged through a comparison of findings side by side. The second phase focused on developing and validating strategies that facilitated the integration of Indigenous Health Systems and Modern Health Systems. The Strengths, Weaknesses, Opportunities, and Threats analysis was applied to interfaced findings from phase one. The Basic Logic and the Build, Overcome, Explore, and Minimise models was used to develop strategies based on the Strengths, Weaknesses, Opportunities, and Threats findings. The developed strategies were validated by applying the Delphi technique and administration of checklist to selected key stakeholders through organised workshops. Results: Through the qualitative inquiry, key attributes, antecedents, and consequences of Health System Strategies on Adolescent Sexual Health were identified. Strategies to Improve Adolescent Sexual Health outcomes were also identified. It was also observed that different stakeholders play varied roles in the upbringing and support of adolescents. However, there are viii contradicting teachings from the Indigenous Health System and Modern Health System. Findings also showed that it was possible to integrate these two systems. However, there were foreseen logistical challenges and clashes in the values and belief systems of the two systems. Umguza district had a significantly higher prevalence of pregnancies, Sexually Transmitted Infections, and a higher number of adolescents who were engaging in sexual activities. Predictors of Sexually Transmitted Infections and pregnancies were the sex of respondent, tribe, sexual encounters, age, and religion. Furthermore, a total of five strategies were proposed to facilitate this integration, and these included revival of committees that were inclusive of all stakeholders; allocating Indigenous Health System space in clinics to work in; establishing adolescent-friendly clinics; intensifying information dissemination on sexual health-related issues; and developing clear Terms of Reference and procedures to govern this integration and ensure it is a success. During strategy validation, experts suggested minor changes to one strategy, and agreed with the other four strategies. The majority of key stakeholders (97%) endorsed the proposed strategies. The strategies were, therefore, refined and presented as per the suggestions of these consulted actors.