This thesis demonstrates challenges with, and provides recommendations for, measurement and attribution of impacts of the young people’s SRH programmes. It identifies the following main challenges with assessing impacts of SBSE programmes: First, long duration of SBSE programmes makes the use of pre- and post-measurements difficult and lengthy. Second, comparable control groups do not exist. Especially with integrated SBSE programmes, which are usually implemented country- or state-wide. Third, reliable SRH outcome data is not available, or even if data is available the challenge with attribution remains. Fourth, there is a delay between sexuality education (SE) and start of sexual intercourse. At the beginning of a SE programme pupils are usually quite young and not sexually active. They become sexually active several years later, and only then impact can be assessed. Impact of YFSRH services is a combined result of healthcare services and health promotion. The challenges with assessing of impacts of YCs’ health promotion activities are similar to SBSE programmes. Comparable control groups and reliable SRH impact data do not exist, and there may also be a delay between health promotion and sexual behaviour. Measuring and attributing impacts of YCs’ healthcare services is easier. YCs usually have records on provided SRH services, which can be used for quantifying primary impacts of the healthcare services.

Despite these challenges, the thesis argues that assessing impact and cost-effectiveness of young people’s SRH programmes is possible. It makes the following recommendations: First, impact- and economic evaluations of young people’s SRH programmes should be combined and planned together in advance. Second, a case-control design is a recommended approach. This requires identification of a comparable control group, or dividing sites randomly into intervention and control groups. Third, base-line measurements should be collected in both groups before the intervention begins. Fourth, special attention should be paid to that data collection captures information needed for cost-effectiveness analysis. Priority should be given to health outcomes, and if these are not available then behaviour change outcomes should be collected. Fifth, a follow-up period should be several years. It is important that individuals can be tracked and followed up over time.


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