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Background: In 2014, Zambia adopted the Comprehensive Sexuality Education (CSE) framework to promote sexual reproductive health and rights (SRHR) in schools. Effective CSE implementation requires multisectoral collaboration with diverse government sectors (education, health, etc.), the community, traditional, and religious leaders. However, research on CSE with a focus on collaboration remains scarce, especially in Sub-Saharan Africa. The overall aim of this thesis was to explore the delivery of the CSE framework in Zambia, with a particular focus on collaborative governance.

Methods: This study employed both a systematic review and a qualitative case study design. Firstly, the systematic review used the thematic analysis to identify factors influencing the integration of CSE into the education system in low- and middle-income countries (Sub-study I). Secondly, the qualitative case study aimed to understand how national policy frameworks (Sub-study II), provincial multisectoral collaboration (Sub-study III), and community system dynamics (Sub-study IV) interact to shape the delivery of CSE in Zambia. We collected data using qualitative interviews with diverse stakeholders representing government, NGOs, religious, and traditional leadership. Qualitative content analysis and reflexive thematic analysis were used as analytical approaches.

Findings: Key factors influencing the integration of CSE into education systems included the nature of the problem, actors’ perceptions, attributes of the intervention, adopting systems, and broader system characteristics. While Zambia’s policy environment supports CSE, contradictions—such as restrictions on contraceptive delivery in schools and social norms that promote child marriage—undermine effective implementation. In addition, the perceived inclusion of abortion and LGBTQ+ related topics increases stakeholders’ resistance towards the implementation of CSE. Furthermore, factors influencing multisectoral collaboration in implementing CSE at the provincial level included a supportive provincial structure that facilitated stakeholder engagement. Nevertheless, this structure was weakened by the exclusion of key groups, limited transparency, and the bypassing of institutional mandates. The study also highlights factors that influence collaborative community health system (CHS) pathways and the barriers to implementing CSE in rural Zambia. Stakeholders from the school, community, health and police sectors participated in facilitating collective delivery of CSE across settings. However, social norms contributed to community resistance in addressing SRHR-related challenges, including child abuse, early marriages, and unintended pregnancies. 

Conclusion: Effective delivery of the CSE framework in Zambia requires a comprehensive multisectoral collaborative governance across all levels. However, this requires strengthening institutional mandates, improved coordination, and collective action in promoting SRHR services, including abolishing some harmful local by-laws that hinder promoting SRHR efforts. 

Mbiri ya ntchito: Mu 2014, Zambia idavomereza ndondomeko ya Maphunziro okhudza Zogonana (Comprehensive Sexuality Education: CSE) kuti ithandize kukweza thanzi la chibadwidwe ndi ufulu wa ana ndi achinyamata (SRHR) m’sukulu. Kuti CSE igwire bwino ntchito, zimafuna mgwirizano wa magawo osiyanasiyana a boma (monga zamaphunziro, zaumoyo, ndi ena), anthu a m’mudzi, atsogoleri achikhalidwe, komanso atsogoleri azipembedzo. Komabe, kafukufuku wokhudza CSE wokhudzana ndi mgwirizano ukusakabe, makamaka ku Sub‑Saharan Africa. Cholinga chachikulu cha thesis iyi chinali kufufuza momwe CSE ikuchitidwira ku Zambia, makamaka potanthauzira ulamuliro wogwirizana (collaborative governance).

Njira za kafukufuku: Kafukufukuyu adagwiritsa ntchito systematic review (kuwunika mwadongosolo) ndi kafukufuku wa qualitative case study design. Choyamba, kuwunika mwadongosolo kunagwiritsa ntchito thematic analysis (kusanthula mitu) kuti apeze zinthu zomwe zimakhudza kuphatikizidwa kwa CSE mu dongosolo la maphunziro m'maiko otsika ndi apakati pa chitukuko (Sub‑study I). Kenako, qualitative case study inali yolingalira kumvetsa momwe malamulo a boma (Sub‑study II), mgwirizano wa magawo osiyanasiyana pa mlingo wa chigawo (Sub‑study III), komanso machitidwe a m’madera a m’mudzi (Sub‑study IV) zimagwirizanirana popanga CSE ku Zambia. Deta idasonkhanitsidwa pogwiritsa ntchito kuyankhulana kwa mtundu wa qualitative (qualitative interviews) ndi omwe amayimira boma, NGOs, atsogoleri azipembedzo, komanso atsogoleri achikhalidwe. Kusanthula kwa zolemba (qualitative content analysis) limodzi ndi reflexive thematic analysis zidagwiritsidwa ntchito pakupanga kusanthula.

Zotsatira: Zinthu zazikulu zomwe zinapezeka kuti zimakhudza kuphatikizidwa kwa CSE mu dongosolo la maphunziro zinkaphatikizapo: momwe vutoli limvelekere, mmene omwe akhudzidwa amaonera pulogalamuyi, khalidwe la pulogalamu ya CSE, momwe machitidwe a boma amalandirira ndondomeko, komanso mikhalidwe ya dongosolo lonse la maphunziro. Ngakhale Zambia ili ndi malamulo othandiza CSE, kusiyana kwa malamulo—kuphatikizapo zoletsa monga kusapereka mankhwala oletsa mimba m'masukulu komanso miyambo yolimbikitsa ukwati wa ana—zimalepheretsa kuchitidwa bwino kwa CSE. Komanso, malingaliro oti CSE ili ndi mitu yokhudza kuchotsa mimba (abortion) kapena LGBTQ+ zimayambitsa kukana kuchokera kwa omwe akhudzidwa. Kuphatikizapo, zinthu zomwe zimakhudza mgwirizano wa magawo osiyanasiyana pa mlingo wa chigawo zinkaphatikizapo dongosolo labwino lomwe limathandiza kutenga nawo mbali kwa omwe akhudzidwa. Komabe, dongosololi limafooka chifukwa chosaphatikiza magulu ena ofunika, kusowa kwa kuwonekera kwa ntchito, komanso kuphwanya maudindo a mabungwe a boma. Kafukufukuyu awonetsanso zinthu zomwe zimakhudza njira za mgwirizano wa okhudzidwa a m’mudzi komanso zopinga pakukhazikitsa CSE kumudzi. Anthu ochokera m’sukulu, m’magulu a m’mudzi, zaumoyo, komanso apolisi anali kutenga nawo mbali polimbikitsa ntchito za CSE. Komabe, miyambo ya m’mudzi inali imodzi mwa zinthu zomwe zimayambitsa kukana kuthana ndi mavuto a SRHR monga nkhanza za ana, ukwati wa msanga, ndi mimba zosafunika.

Pomaliza: Kuti CSE igwire bwino ntchito ku Zambia, zikufunika mgwirizano wamphamvu pakati pa magawo onse kuyambira pa mlingo wa boma mpaka kumudzi. Zikufunikanso kulimbitsa maudindo a mabungwe, kusintha mgwirizano, ndi kulimbikitsa ntchito za limodzi pothandiza SRHR—kuphatikizapo kuchotsa malamulo ndi miyambo yowononga yomwe imalepheretsa kukwezedwa kwa SRHR.