Viewpoint on Family Life and HIV Education curriculum in Nigerian secondary schools.

Introduction

The epidemic proportions of HIV/AIDS infection reached in the late 1990s and early 2000s in Nigeria[1] led the National Council on Education to approve implementation of the Family Life and HIV Education (FLHE) curriculum in Nigerian schools during its 49th council meeting in 2002.[2] School-based HIV/AIDS education is an intervention strategy to provide information on HIV/AIDS to young people who are in school.[3] The FLHE curriculum for junior secondary schools in Nigeria was developed in 2003, to guide this strategy.[2,4,5] The FLHE entails a planned process of education aimed at acquiring factual information; the formation of positive attitudes, beliefs, and values; as well as development of skills to cope with biological, psychological, sociocultural, and spiritual aspects of human life.[4] The Nigerian FLHE curriculum was developed by the Nigerian Educational Research and Development Council through a highly participatory and consultative process that involved a wide cross-section of stakeholders, including nongovernmental organizations (NGOs) across the six geopolitical zones of Nigeria, whose views and reviews helped to shape and ensure national coverage and sociocultural applicability of the FLHE curriculum to the diverse communities throughout the country.[4] The main goal of the curriculum is the promotion of awareness and prevention against HIV/AIDS. As presently structured, the FLHE curriculum for junior secondary school in Nigeria stands as an initial point for developing a comprehensive approach to humanity education and also serves to guide national school curriculum integration efforts at all levels of education in Nigeria.[4] The curriculum comprises six themes: human development, personal skills, sexual health, relationships, sexual behavior, and society and culture.[4] Each theme comprises a number of topics, which in turn contain specified performance objectives with corresponding learning contents and activities, teaching and learning materials, and appropriate evaluation guides.

The FLHE curriculum has some special attributes, such as practical and learner-centered educational activities; spirally arranged content to ensure continuity and increasing depth of understanding as students move to higher levels; and adoption of a thematic approach in the selection and organization of content, to ensure comprehensiveness and avoid curriculum overload. Inclusion of these elements ultimately leads to the achievement of the stated curriculum objectives.[4] To support the effective implementation of the FLHE curriculum, some mechanisms have been put in place in some Nigerian states as interventions of FLHE. These include development of a schematic of work and instructional materials, policy advocacy, and resource mobilization; human resource development and capacity-building for teachers; management teams and inspectors; monitoring and evaluation for quality assurance; and strengthening of partnership between government and NGOs interested in the FLHE.[5]

Prior to introduction of the FLHE and its related interventions in Nigeria, there was a high prevalence of HIV/AIDS among adolescents. For instance, among all reported HIV/AIDS cases in Nigeria in 1998, 60% were in the adolescent age group 15 to 24 years, which makes up about 50% of the Nigerian population.[4] However, this trend was improved upon in later years, as evident in a 2016 report where about 240,000 adolescents (aged between 10 and 19 years) were reported to be living with HIV/AIDS, representing about 7% of the total number of people living with HIV in Nigeria.[2,6] This report suggests that the FLHE and its related interventions have had a substantial impact in the fight against HIV/AIDS, especially among adolescents. Hence, there is a need to strengthen the FLHE curriculum, for greater effectiveness and impact, to promote good health and well-being at all ages—one of the United Nations Sustainable Development Goals.[7] Therefore, as efforts are ongoing in different sectors to strengthen various systems that are in place to combat the spread of HIV/AIDS,[8] similar actions are needed in the education sector. Several authors have drawn attention to the issue of HIV/AIDS and sexual abuse within adolescent health and sexuality and the relevance of the FLHE curriculum in schools.[9-18] The FLHE curriculum drives school-based HIV/AIDS intervention strategies; thus, the curriculum needs to undergo constant review and innovation with respect to current realities, to strengthen and improve FLHE. To this end, the aim of this paper was to highlight strengths and drawbacks identified in the FLHE curriculum and its implementation and to suggest possible solutions for boosting its effectiveness and impact.

Methodology

With a focus on the FLHE curriculum in Nigeria, we performed a search for relevant information published in the gray literature, national dailies, theses, websites, and peer-reviewed journals. All sources were considered equally, because no inclusion or exclusion criteria were used. We used Google and Google Scholar search engines, as well as databases such as Scopus and PubMed, to search for information between December 2018 and January 2019. The following search terms and phrases were used: “HIV education”, “HIV education in Nigeria”, “Curriculum innovation for HIV prevention”, “HIV prevention”, “HIV prevention in Nigeria”, “HIV facts”, and “Evaluation of the FLHE curriculum in Nigeria”. This review method has been used in recent research to discuss issues related to school and community health.[19-21] The authors independently extracted information from the various sources and then cross-checked the information obtained in preparing the final draft of this paper. Ethics approval and informed consent was not required for this review.

Results and discussion

In our literature search, we identified some observations concerning the present FLHE curriculum, based on its general aim and content. Contrary to the general aim of the FLHE (which is basically sexual health), the curriculum conveys stronger messages about sex and gender than sexual health.[16] It was noted that while similar curricula in countries such as New Zealand and Bangladesh[3,9] ignored gender-based issues such as early marriage, sexual coercion, gender-based violence, harmful practices, human trafficking, and girls’ assertiveness, the FLHE curriculum touched on all of these.[16] However, with regard to sexual health content, which should have a stronger emphasis, the Nigerian secondary school FLHE curriculum is notably weak, being mainly focused on abstinence and omitting other core contemporary sexual health issues related to young people such as abortion, contraception use, masturbation, and sexual diversity.[16] Neglecting these issues limits the potential effectiveness and impact of the FLHE curriculum.

Initially, the FLHE was incorporated into two core subjects in junior secondary school, social studies and basic science. However, following government directives to distribute FLHE topics among several other subjects in junior secondary school, the FLHE curriculum now appears to be included within four subjects—social studies, home economics, health and physical education, and basic science—in most states in Nigeria.[10,16] Considering the allowance given to states to further modify the content of the FLHE curriculum in consideration of local circumstances,[10,16] this distribution is of great concern because it makes it impossible to have a common national template for monitoring and evaluation of the curriculum’s impact and effectiveness and can also result in curriculum overload. In terms of coverage, the FLHE curriculum as it is presently constituted mainly targets adolescents in school. This raises questions as to the fate of adolescents who are not attending school, married adolescent girls, and other vulnerable groups, such as those in remote areas of Nigeria.[12]

With respect to implementation, many pertinent issues have been observed that have limited the effectiveness of the FLHE curriculum. First of these is the school level at which the FLHE curriculum is currently implemented. Presently, there is one FLHE curriculum for upper primary (grades 3 to 6), junior secondary, senior secondary, and tertiary school levels.[13,16] However, the decision was made to first focus on junior secondary schools in curriculum implementation because it is believed that students at this level are still forming their attitudes towards sexuality and gender/sex and that most are not yet sexually active.[16] However, we have a different opinion, given (among other things) the rampart sexual child abuse reported across Nigeria on an almost daily basis.[17] We believe that a more robust program that captures students early (from upper primary level) and can guide them through at least post-secondary school would be far more effective. In fact, given their maturity and exposure, senior secondary school students are likely to appreciate more of the FLHE curriculum content than their junior counterparts. Other identified school-level constraints to the effective implementation of the FLHE curriculum include the lack of commitment and support from concerned bodies; the lack of well trained and actively involved educators and instructors; gross inadequacy of teaching materials, students manuals, and other learning aids; insufficient teaching time; disapproval of openness about sexuality; and the lack of a suitable environment for proper implementation.[10-13] Other drawbacks of the curriculum include poor record keeping of FLHE activities and reports, resulting in a lack of pertinent statistics; poor monitoring and supervision; and poor coordination among government and nongovernment stakeholders.

Some previous empirical studies have been carried out to ascertain the effectiveness of the FLHE curriculum in different periods.[13,16,22-25] Although these are small-scale studies in terms of geographical coverage and study period, they shed some light on the effectiveness of FLHE in Nigeria. Some gains have been reported, such as higher knowledge scores on health issues related to sexuality and reproduction, acknowledging gender roles and equality, ability to delay sexual gratification and pleasure, boys being less prone to pressuring girls for sex, and girls being more emboldened to say no to boys who demand sex.[22-25] However, some constraints were also identified.[13,16,22-25] Together with the various issues identified above that limit the efficiency and effectiveness of the FLHE curriculum, these constraints could be resolved by adopting the following actions to ensure greater impact. First, the government should conduct a large-scale nationwide assessment and evaluation of the present FLHE curriculum to measure its effectiveness and impact. Similar actions in the past have mostly been done on a small scale; thus, the results lack generalizability.[18] Second, we agree with the popular opinion that currently advocates for a curriculum in which FLHE is treated as a single subject from primary to secondary school and is compulsory for all students.[11] This will inevitably facilitate more effective implementation, monitoring, and evaluation of the curriculum. Third, the FLHE curriculum should be expanded to accommodate programs targeting adolescents who are not attending school. This could include providing information via radio or TV broadcasts, using popular social media platforms, and engaging faith-based organizations, among others. Fourth, most school-related implementation constraints to the FLHE curriculum can be overcome with dedicated commitment backed by actions, especially on the part of government and nongovernment stakeholders that oversee the FLHE project. This will ensure that teachers are properly trained and acquire relevant pedagogical skills for teaching the various FLHE curriculum contents. In addition, necessary teaching aids, learning materials, and other financial and moral support should be given to teachers, together with a conducive learning environment, to boost teacher morale and effectiveness.[10-14] Finally, relevant bodies such as the National Agency for the Control of AIDS and various state ministries of education should adopt modern solutions for effective monitoring and coordination, data collection and storage, and general oversight functions of the FLHE project.

Conclusion

Nigeria’s adoption of the FLHE curriculum as a strategy to curb HIV/AIDS spread in the country, especially among secondary school students, is a step in the right direction. Many research works have demonstrated the importance of this approach; therefore, there is a need to sustain and strengthen the curriculum. In this regard, our work focused on highlighting some of the strengths and drawbacks in the FLHE curriculum and its implementation. To improve effectiveness and boost the impact of the FLHE school curriculum, we recommend greater collaboration and sharing of ideas and experiences among the various education sectors engaged in the effort to lower HIV prevalence. This will provide the more relevant and up-to-date information needed for constant innovation of the FLHE curriculum in Nigerian secondary schools.