Agency

The goal of this randomized controlled trial is to learn if comprehensive sexuality education (CSE) and access to mobile sexual and reproductive health (SRH) services in secondary schools can improve short- and long-term health, well-being, social and economic outcomes among adolescents and young people in two districts of Sierra Leone. The main questions it aims to answer are: 1. How do CSE and mobile SRH services (individually and combined) change adolescent SRHR, well-being and socioeconomic outcomes in the short term and in the longer term (over 3 years)? 2. What are the economic costs of providing CSE and mobile SRH services? 3. How cost-effective is the provision of CSE and mobile SRH services, given its potential impact on health, socioeconomic, and well-being outcomes? 4. To what extent are CSE and mobile SRH services being implemented according to the original plan and timeline? Researchers will compare schools receiving CSE and mobile SRH services to schools not receiving these services, to see if adolescent SRHR, well-being and socioeconomic outcomes are better in those schools that received the services. The trial will compare four groups of schools, each with 60 participating schools: 1. No additional services (control schools) 2. Only CSE 3. Only mobile SRH services 4. CSE and mobile SRH services The implementation of these services will be led by Marie Stopes Sierra Leone (MSSL) in collaboration with the Ministry of Education. MSSL will ensure that participating schools: * Attend teacher training on the CSE curriculum before the study starts, followed by yearly refresher training during the study * Have sufficient time allocated to CSE in the weekly school schedule * Have adequate teaching materials \& equipment to teach CSE * Have guidance counsellors in each school who will monitor the implementation of CSE * Have a designated "safe space" which adolescents can access for menstrual products and care. * Have access to mobile SRH services (provided by MSSL staff) on the school premises 3 times per school year

This study evaluates an Empowerment Agency Training (EAT) intervention within the SPHERES programme that aims to strengthen personal agency among workers in primary healthcare centers (Puskesmas) in Indonesia. The intervention focuses on building self-efficacy, behavioural control, leadership, and intentional decision-making through structured training, follow-up action planning, observational support, and sustainability-oriented incentives. Strengthening personal agency is expected to improve the use of data for decision-making and the delivery of priority primary health services at the Puskesmas level.