From leadership research to district action: Exploring multisectoral collaboration in implementing comprehensive sexuality education framework at the provincial level in Zambia: a qualitative study

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

ABSTRACT Background In 2014, the Zambian government introduced the Comprehensive Sexuality Education (CSE) framework, decentralising its implementation from the national to the provincial administration. The provincial structures of the Ministries of Health and Education play an important role in providing technical, policy direction and coordination support. However, little research has focused on the role of CSE collaboration at the provincial level. Objectives This study sought to explore multisectoral collaboration dynamics influencing the implementation of the CSE framework at the provincial level in Zambia. Methods This qualitative study involved 29 interviews with diverse stakeholders at the provincial level such as government departments (health, education, etc.), private sector, religious and traditional leaders involved in CSE implementation. We used reflexive thematic analysis, guided by an integrative collaborative governance framework. Results The findings were grouped under collaboration dynamics domains: principled engagement, shared motivation, and capacity for joint action. Barriers to principled engagement included provincial structures and their mandate, exclusion or sidelining of certain actors, inadequate financial transparency, and weak formal relations. Shared motivation included collective understanding of the purpose, a supportive policy environment and consensus in adapting the CSE framework. Capacity for joint action efforts included collaborative training of teachers, joint monitoring, and collaborative to address SRHR challenges. Conclusion This study highlights challenges limiting meaningful engagement, exclusion of some actors, financial constraints, and weak coordination, which hinder collaboration. There is need for enhancing provincial leadership capacity to effectively coordinate stakeholders through enforcement of transparent resource management, collective planning, implementation and monitoring for effective CSE delivery PAPER CONTEXT Main findings: Provincial structures and their mandate were key aspects that facilitated principled engagement. However, barriers such as exclusion or sidelining of certain actors, inadequate financial transparency, and weak formal relations limited meaningful engagement. Added knowledge: This study highlights key factors influencing collaboration dynamics in the delivery of CSE, focusing consisting of open collaboration, collective commitment, and collaborative effort in Zambia. Global health impact for policy and action: There is greater need in Zambia to strengthen the provincial leadership capacity and power in the enforcement of transparent resource management, collective planning, equitable resource allocation, implementation and monitoring of CSE programmes.

Study methods

Zambia is a low middle-income country located in central-southern Africa, subdivided into ten provinces. The governance systems and powers are decentralised to the provincial administration, which plays a significant role in providing policy implementation and service delivery. This study was conducted in Eastern Province, home of 16 districts, as illustrated in Figure 2. Currently, Eastern Province ranks second in SRHR challenges, with specifically high rates of adolescent pregnancies and marriages. Intricate social and ecological factors shape these SRHR challenges, with high rates of poverty contributing to increased unemployment and vulnerability levels, as 60% of the population lives on less than $1.90 per day [13].

Limitations

This study provides a comprehensive analysis of the provincial case of multisectoral collaboration dynamics influencing the implementation of CSE in Eastern Province, Zambia. While it may not be possible to transfer the findings to the general pattern of collaboration dynamics across all the provinces, one should interpret them within this context, and we have made efforts to describe the context thoroughly so that the reader can judge the transferability of our findings to other contexts. We further documented the research context to help interested readers to assess the possibility of transferring the findings to similar contexts. The inclusion of national-level stakeholders from both government and private organisations facilitated an in-depth understanding of the pattern of collaboration dynamics lessons influencing the implementation of CSE in Zambia. This further enabled us to uncover specific knowledge on factors, challenges, and opportunities that affect effective implementation and integration of CSE in schools. Another strength of the study is the use of the theoretical framework to guide its development and implementation. The framework enabled us to analyse the rich data source and generate an in-depth understanding of the collaboration perspective. However, we limited the analysis to exploring collaboration dynamics, leaving out other crucial components of the framework such as actions and outcomes. These excluded parts of the framework will be explored fully in a separate study.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Pilot a structured team debrief in one voluntary staff team. Invite dissent, record a specific improvement action and assign responsibility without collecting identifiable criticism. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Compare participation distribution, action completion, near-miss reporting and a consistent voluntary team-climate measure. Increased reporting may reflect greater openness rather than more errors. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Malizgani Paul Chavula; Joseph Mumba Zulu; Isabel Goicolea; Anna-Karin Hurtig. Exploring multisectoral collaboration in implementing comprehensive sexuality education framework at the provincial level in Zambia: a qualitative study. Global Health Action (2025-08-29). https://doi.org/10.1080/16549716.2025.2547436

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.