1. The road to national adoption: a mixed-methods study study of Grassroot Soccer’s partnership programme in Ethiopia Harare, Zimbabwe ICASA 2015

3. Youth Socce r HIV Grassroot Soccer Mission: Grassroot Soccer uses the power of soccer to educate, inspire, and mobilise communities to stop the spread of HIV. Vision: A world mobilised through soccer to create an AIDS free generation.

4. Over 1 million youth worldwide have graduated from our HIV prevention programmes = GRS programming

5. Background National Adoption Large need for effective life skills education in primary and secondary schools across sub-Saharan Africa Common challenges with national adoption: o Life Orientation not seen as a priority school subject o Building relationships with Department of Education o Operating alongside many other HIV prevention NGOs offering life skills education in schools

6. Background Launch of SFL in 2004 Initial partnership with the Academy for Educational Development (AED), now FHI 360, as part of the Health Communications Partnership (HCP) Designed curriculum and conducted initial training of teachers/peer educators Informal collaboration going forward

7. Timeline from conception to national adoption, SFL in Ethiopia

8. Objectives of SFL Mixed-Methods Study 1.Explore the reasons for scale-up and national adoption of SFL. 2.Explore the quality and reach of SFL programming among youth beneficiaries in Ethiopia.

9. Methods Attendance data Collected and tracked from 2004-2014 by various implementing organizations 18-item paper-based questionnaire Administered to SFL participants from peri-urban communities in Addis Ababa (n=297) Analysis conducted to compare SFL questionnaire with results from pre/post questionnaires administered to GRS-managed sites across South Africa in 2013 (n=3,483) Qualitative data 3 focus group discussions (FGDs) conducted with SFL participants (n=1 group), Partners for Health trainers (n=1 group), and SFL-trained teachers (n=1 group) 3 key informant interviews conducted with Ethiopia-based organizations Observations of 2 SFL sessions

10. ATTENDANCE DATA

11. Attendance Data Attendance data from SFL implementing partners in Ethiopia, 2004-2014 *Implementing partners did not collect participant-level attendance data **A participant was defined as a student who attended at least one SFL session

12. QUESTIONNAIRE FINDINGS

13. Questionnaire Findings: Basic Demographics SFL questionnaires Analysis restricted to 275 of 297 participants that completed both the pre and post questionnaire (46% male; 53% female; 1% not specified) Median age of participants: 15 years (interquartile range: 14-16 years; full range 12-33 years) GRS South Africa questionnaires: All 3,483 participants included in the analysis (45% male; 55% female) Median age of participants: 12 years (interquartile range: 12-13 years; full range: 10-15 years)

14. Questionnaire Findings: Pre/Post Responses Question-by-Question Analysis for SFL Participants in Ethiopia, 2013

15. Questionnaire Findings: Pre/Post Comparison Analysis Question-by-Question Comparison Analysis Between Participants in Ethiopia and South Africa, 2013

16. QUALITATIVE FINDINGS

17. Political environment and government collaboration Ethiopian government was mandating the implementation of youth-targeted HIV education in schools Ministry of Education (MoE) was working with Ministry of Youth, Sports and Culture (MYSC) to integrate HIV education component into their sport and life skills programming “There was a void…but it was not really activated until we showed up. So it was win-win, [the MYSC] were happy to see us, and we were happy to see them.” – Key informant AED (now FHI 360) included MoE early on in in the SFL design phase

18. Training and monitoring Providing high-quality training and frequent monitoring to support the scale-up of SFL was vital “Our Master Trainers were trained by [GRS]. And those Master Trainers conducted the training to school teachers, and those school teachers also take their assignment to cascade the training to their students.” – Key informant Refresher trainings were conducted bi-annually and HCP staff members conducted school visits to monitor the quality of implementation The teachers were also supported by a governmental structure called the Regional Education Bureaus

19. Partnership-building HCP staff members continuously engaged other Ethiopian NGOs around SFL Many ended up becoming partners in the SFL project and implementing it as well “I think those partners, their programmes were focusing on youth. But, they don’t have the component like the SFL programme. Their approach was not like interactive, participatory, so after we introduced this programme, they showed their interest.” – Key informant This early engagement of NGOs allowed SFL to sustain itself after the USAID funding ended in early 2011

20. Views on sport-based methodology Participants, SFL-trained teachers and HCP staff members preferred SFL to formal education “We learn on SFL with games and physical activities and we will not get bored and forget the points. But, in school, we may not be that interesting. ” – SFL participant “[The classroom lesson] starts in the classes and end there. SFL happens on the field with fresh air and involves games. Students easily understand the key messages. It is more understandable and it would be better if the formal education may be provided in the same method so that students will learn more.” – SFL-trained teacher Teachers and participants also felt that SFL allowed them to speak openly about sensitive topics, such as HIV-related stigma and discrimination

21. CONCLUSIONS

22. Conclusions SFL participants demonstrated high baseline knowledge of HIV and HIV prevention methods SFL participants demonstrated similar short-term changes in HIV-related knowledge, attitudes and communication as participants reached at GRS- managed sites The political environment and government collaboration seemed to influence the rate of SFL scale-up and national adoption Champions from the HCP project drove the success of SFL The SFL sport-based methodology was highly accepted due to its novelty and interactive component

23. Study Limitations Accuracy of attendance data –Many stakeholders implementing SFL lack participant-level data SFL questionnaire and FGDs only conducted with participants in Pact Ethiopia’s after-school SFL programmes in Addis Ababa No long-term follow-up with the pre/post questionnaire Pre/post questionnaire comparison analysis –Median age of Ethiopian participants was higher than median age of South African participants –P values and confidence intervals were not calculated given limited data available on clusters Lack of a control group

24. Acknowledgements Collaborators Rebecca Hershow 1, Jamison Merrill 2, Katherine Gannett 2, Elsabeth Tsegaye 3, Kirk Friedrich 4, Jeff DeCelles 1,4 1 University of North Carolina Gillings School of Global Public Health 2 London School of Hygiene & Tropical Medicine 3 Partners for Health 4 Grassroot Soccer Advisors Tommy Clark Implementation Staff Pact Ethiopia, Partners for Health, FHI 360, Johns Hopkins University Center for Communications Partnerships, Grassroot Soccer South Africa Funding