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Background School-based sexuality education is instrumental in promoting health and well-being of adolescents and young people. While countries across sub-Saharan Africa have made significant progress in improving adolescents’ and young people’s sexual and reproductive health and rights, school-based sexuality education policy, curriculum development and implementation need further advancement. This paper aims to contribute to enhancing the effectiveness and sustainability of sexuality education programmes, by sharing lessons learned from the mixed-methods evaluation of the ‘Our rights, Our lives, Our future’ programme across 33 countries in sub-Saharan Africa (2018–2022). Methods The evaluation employed mixed methods. It started with a review of 35 programme documents, after which ten qualitative country case studies and 15 regional and global-level interviews with key stakeholders were conducted. The case studies were conducted in Botswana, Burundi, Cameroon, Côte d’Ivoire, Eswatini, Gabon, Malawi, Nigeria, Uganda and Zambia. They included a total of 34 focus groups discussions with adolescents, teachers and parents; 76 key informant interviews; and nine stakeholder learning sessions. Data from each method were triangulated and synthesised based on an evaluation framework. Results Findings show that the programme made a substantial contribution to keeping sexuality education on the political agenda in a context of growing opposition. The programme’s support to national governments also led to significant progress in the development and adoption of sexuality education curricula. In many settings, the delivery of sexuality education was hampered by limited competencies and sometimes negative attitudes of teachers, and a lack of support in the school and community environment, including a lack of support from parents. Conclusions Continued efforts are needed for supporting sexuality education policy processes and sustainable implementation in sub-Saharan Africa. There is a need for collaborative advocacy and countering opposition. Improving the quality of sexuality education delivered in schools also requires continuous attention. Such efforts need the engagement of multiple stakeholders, including adolescents and young people themselves. Plain English summary Sexuality education in schools promotes the health and well-being of adolescents and young people. Countries in sub-Saharan Africa have made significant progress in improving adolescents’ and young people’s sexual and reproductive health and rights. However, it is known that sexuality education in schools needs to be improved. This paper aims to contribute to more effective and sustainable sexuality education programmes, by sharing lessons learned from the evaluation of the ‘Our rights, Our lives, Our future’ programme (2018–2022). This programme supported 33 countries in sub-Saharan Africa in the promotion of sexuality education in schools. Findings show that the programme made a substantial contribution to keeping sexuality education on the political agenda, in a context of growing opposition. The programme’s support to national governments also led to significant progress in the development and implementation of sexuality education curricula. In many countries, the delivery of sexuality education was hampered by limited competencies and sometimes negative attitudes of teachers. In addition, there was often a lack of support for sexuality education from parents and other community members. Continued efforts are needed for supporting sexuality education policy processes and sustainable implementation in sub-Saharan Africa.

Progress The last two decades have seen a growing focus on intersectoral interventions to improve maternal and newborn health and well-being outcomes, as reflected in efforts to achieve the Millennium Development Goals (MDGs) and advance the Sustainable Development Goals (SDGs). Preterm births are linked to cross-sectoral determinants that affect health outcomes and human capital across the life-course, necessitating an intersectoral approach that addresses these multifaceted challenges. Programmatic priorities Recognizing that social, biological and economic determinants significantly influence health outcomes, it is critical that robust health systems are reinforced by a comprehensive intersectoral approach. Evidence suggests that the factors influencing preterm birth, and the health of small and sick newborns are vast and varied, requiring interventions that address equity and rights, education, economic factors, environmental conditions, and emergency responses, i.e., a new framework entitled \"five Es\". Pivots Improving outcomes for newborns, including preterm and small for gestational age babies, and preventing stillbirths, requires enhanced measurement and accountability within intersectoral programs across the 'five Es'. Investment in equity-focused, gender-transformative, and rights-based policies and programs across various sectors is crucial. Priority areas include ensuring equitable and inclusive education, particularly comprehensive sexual and reproductive health education; developing innovative financing schemes that protect and support families with complicated pregnancies and vulnerable infants; creating environmentally adaptive systems that prioritize maternal and newborn health; and implementing emergency response plans that guarantee the continuity of maternal and newborn health services. Evidence-based intersectoral interventions offer a promising pathway to reducing preterm births and improving health outcomes across generations. By addressing the five Es, intersectoral interventions can create a healthier future for preterm babies, children, adolescents, women, and society as a whole. Plain Language Summary Improving health requires action from many different areas beyond the health sector. Factors like income, environment, education, and access to quality services all impact the health of women and babies. This paper specifically looks at how these factors affect preterm births—babies born before 37 weeks—and how working across sectors can help address this challenge. Many factors influence preterm births and newborn health, so solutions must focus on equity and rights, education, the environment, economy, and emergency response—the \"five Es.\" To improve survival rates and quality of life for preterm babies, we need better tracking, coordination, and accountability for programs addressing these areas. Investing in these efforts leads to better outcomes and prevents preterm births. To support vulnerable newborns, key priorities include making education more inclusive, especially sexuality education; supporting families with preterm babies through protective financial systems; improving health system capacity to adapt to environmental challenges; and creating emergency response plans that prioritize mothers and newborns. By focusing on the five Es, intersectoral approaches can reduce preterm births and improve health for future generations. Key findings Progress • In the past two decades, there has been a growing focus on intersectoral interventions to improve maternal and newborn health, to firstly achieve the MDGs and advance the SDGs. • Intersectoral action can reduce preterm births, benefiting mothers, babies, and future generations while enhancing human capital. Programmatic priorities • Intersectoral determinants affect women and their vulnerable newborns throughout the life-cycle. • The \"five Es\"—equity and rights, education, economy, environment (including nutrition and climate) and emergencies—need urgent attention through targeted evidence-based interventions. Pivots It is essential to invest in building equity-focused, gender-transformative and rights-based policies and programmes across sectors, prioritizing: • equitable and inclusive education, including comprehensive sexuality education; • innovative financing schemes that protect and support families with preterm babies; • environmentally adaptive systems that prioritize maternal and newborn health; • emergency preparedness and response plans that ensure the continuation of maternal and newborn health services

Whilst significant progress has been made in recent years with respect to advancing health and education, the ESA region's young people still experience challenges in relation to their SRHR. This study brings together learning from the available data and reports, as well as the experiences of those closely connected with the process of affirmation/endorsement and implementation of the ESA Commitment between 2013 and 2018. Whilst challenges remain - particularly in relation to monitoring and accountability - the ESA Commitment has instigated notable progress, made possible in part by the emphasis on multisectoral collaboration between health and education sectors nationally and regionally. Sustained political, technical, and financial investment in young people's health and rights will ensure that the countries of the region are able to build upon these successes and deliver on their commitments to young people during this decade of action towards the realisation of the SDGs and harnessing the demographic dividend for Africa for years to come.

Nicola Gray and colleagues examine the mutual reinforcement of adolescent health and education, the challenges of intersectoral working, and the joint investment needed to secure wellbeing during adolescence, into adult life, and for the next generation

The last two decades have seen a growing focus on intersectoral interventions to improve maternal and newborn health and well-being outcomes, as reflected in efforts to achieve the Millennium Development Goals (MDGs) and advance the Sustainable Development Goals (SDGs). Preterm births are linked to cross-sectoral determinants that affect health outcomes and human capital across the life-course, necessitating an intersectoral approach that addresses these multifaceted challenges. Recognizing that social, biological and economic determinants significantly influence health outcomes, it is critical that robust health systems are reinforced by a comprehensive intersectoral approach. Evidence suggests that the factors influencing preterm birth, and the health of small and sick newborns are vast and varied, requiring interventions that address equity and rights, education, economic factors, environmental conditions, and emergency responses, i.e., a new framework entitled \"five Es\". Improving outcomes for newborns, including preterm and small for gestational age babies, and preventing stillbirths, requires enhanced measurement and accountability within intersectoral programs across the 'five Es'. Investment in equity-focused, gender-transformative, and rights-based policies and programs across various sectors is crucial. Priority areas include ensuring equitable and inclusive education, particularly comprehensive sexual and reproductive health education; developing innovative financing schemes that protect and support families with complicated pregnancies and vulnerable infants; creating environmentally adaptive systems that prioritize maternal and newborn health; and implementing emergency response plans that guarantee the continuity of maternal and newborn health services. Evidence-based intersectoral interventions offer a promising pathway to reducing preterm births and improving health outcomes across generations. By addressing the five Es, intersectoral interventions can create a healthier future for preterm babies, children, adolescents, women, and society as a whole.