/ 20 District Health Boards
PUBLIC HEALTH SERVICES -
SEXUAL HEALTHPROMOTION SERVICES
TIER LEVEL TWO
SERVICE SPECIFICATION
Status:
This service specification may be amended for agreements as required to meet local needs. / NON-MANDATORY
Review History / Date
Approved by Nationwide Service Framework Coordinating Group (NCG)
Published on NSFL
Review:Public Health Handbook (2003) Amendments: use of standards service specification template,update of background (statistics), editing and wording changes relating to change in delivery emphasis, addition of sections on definitions, quality, Service users, purchase units, linkages, and exclusions. / April 2010
Change of status to non-mandatory as an interim step before the specification is retired or replaced / November 2016

Note:Contact the Service Specification Programme Manager, Ministry of Health, to discuss the process and guidance available in developing new or updating and revising existing service specifications. Nationwide Service Framework Library website http://www.nsfl.health.govt.nz/.

PUBLIC HEALTH SERVICES -

SEXUAL HEALTH PROMOTION SERVICES

TIER LEVEL TWO

SERVICE SPECIFICATION

This tier two service specification for Public Health Services - Sexual Health Promotion Services (the Service),must be used in conjunction with the overarching tier one Public Health Services Specification.

Refer to the tier one Public Health Services service specification for details under the following headings fro generic details on:

  • Service Objectives
  • Service Users
  • Access
  • Service Components
  • Service Linkages
  • Exclusions
  • Quality Requirements

The above heading sections are applicable to all service delivery.

1.Service Definition

Sexual health is the experience of the ongoing process of physical, psychological, and socio-cultural well-being related to sexuality. Sexual health is evidenced in the free and responsible expressions of sexual capabilities that foster harmonious personal and social wellness, enriching individual and social life.

Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system.

This Service relates to the Public Health Services health promotion programmes that contribute to the improvement of sexual and reproductive health and wellbeing.

For definitions of sexual health related terms used in this document see Appendix One.

2.Service Objectives

2.1General

The Service objectives are to:

  • improve the sexual and reproductive health status of New Zealanders, including:

­delayed onset of sexual activity amongst young people

­improved access to contraceptive information

­reduced rates of unintended pregnancy

­reduced transmission of STIs including HIV infection

­reduced rates of abortion

  • reduce inequalities in sexual and reproductive health status (including between Māori and other New Zealanders) and:

­provide support for the development of sexual and reproductive health services delivered by Māori for Māori

­improve mainstream service responsiveness to Māori

­provide a more supportive social environment which acknowledges differences in sexual orientations.

  • support the development of healthy public policy in relation to sexual and reproductive health.
  • assist in the development of supportive school environments for the sexual health of adolescents. This will include supporting programme and policy development in schools towards realistic, comprehensive sexuality education programmes for adolescents
  • provide sexuality training to professionals, parents,caregivers, and tertiary students
  • deliver targeted sexual health education services to those at high risk from STIs including HIV/AIDS, including men who have sex with men, and sex workers.

2.2Māori Health

Refer to the tier one Public Health service specification.

3.Service Users

Service users for sexual health programmes include all New Zealanders. However, providers should focus on effective and available sexual health services and programmes for Māori, Pacific peoples, young people, people with disabilities, men who have sex with men, and sex workers.

Increasing the ability of families and caregivers to support their children and young peoples to make healthy sexual and reproductive health decisions is also a priority.

4.Access

Access to sexual health promotion programmes is for all New Zealanders,but with an emphasis on effective and available services for Māori, Pacific peoples, young people, people with disabilities, men who have sex with men, and sex workers.

5.Service Components

5.1Contribute to the development of policies and social environments, that support improved sexual and reproductive health status

  • Provide evidence-based input to policy development processes at national, regional and local levels, where this input can contribute to a social environment conducive to responsible and safe sexual behaviour.
  • Assist schools and Boards of Trustees with the development of sexual health policies and practices, which create a safe and supportive environment for students and encourage responsible and safe sexual behaviour.
  • Promote strategies at a national, regional and local level which support improved sexual and reproductive health status.

5.2Support youth development and community action approaches promoting sexual and reproductive health

  • Facilitate and manage the development and implementation of evidence-based community and school-based sexual and reproductive health programmes. Ensure approaches are consistent with The Youth Development Strategy Aotearoa.[*]
  • Increase community awareness about sexual and reproductive health issues
  • Develop and deliver evidence-based public awareness campaigns in response to identified sexual and reproductive health issues, where appropriate. This will include accurate information on STIs (including HIV/AIDS) and their modes of transmission, safer sexual practices including condom use, contraceptive use, and alternatives to penetrative sexual intercourse including delaying onset of sexual activity, both delivered to the general population and targeted to those at high risk of STI infection.
  • Develop, produce and distribute sexual and reproductive health education resources, including newsletters, brochures, teaching kits and fact sheets, which support public health programme delivery and referral information. Any development of new resources or revision of old resources should first be approved by the Ministry of Health. New resources need to comply with Ministry of Health guidelines and standards on resource development.
  • Contribute to and organise community forums, education sessions and workshops on sexual and reproductive health.
  • Support the delivery of sexuality education programmes to schools that promote the development of healthy sexuality, and acknowledge and are inclusive of differences in sexual orientation. Sexuality education programmes should take account of the following nine criteria for effectiveness:

­focus on identified behavioural goals, e.g., delaying initiation of intercourse or using contraception

­based on theoretical approaches which have been demonstrated to be effective in influencing other health-related risk behaviour – e.g., social cognitive theory, social influence theory, social inoculation theory, cognitive behavioural theory

­behavioural goals, teaching methods and materials appropriate to the age, sexual experience and culture of students

­ideally, programmes should last 14 or more hours in total. Where this is not possible, programmes lasting a smaller number of hours should be implemented in small group settings with a leader for each group, and reinforce risk behaviour goals from other topic areas such as tobacco, alcohol and drugs

­teaching methods should involve the participants and enable them to personalise the information

­basic, accurate information should be provided about the risks of unprotected sexual contact and methods of avoiding unprotected sexual contact

­programmes should include activities that address social pressures on sexual behaviours

­programmes should provide modelling and practice of communication, negotiation and refusal skills

­teachers or peers who believe in the programme and are well trained should deliver the programme.

5.4Strengthen strategic alliances and interagency networks to promote sexual and reproductive health

  • Work collaboratively with other sexual and reproductive health promotion providers to promote and support related community-based programmes developed by other agencies.
  • Provide training services, resources and assistance to Māori providers of sexual health services as requested by Māori.
  • Develop formal relationships with other providers and representatives of other sectors where this will improve the coordination and delivery of sexual and reproductive health services.
  • Maintain good working relationships with key personal health providers to ensure the best possible sexual and reproductive health outcomes.
  • Strengthen skills and knowledge of the health sector and other change agents to promote sexual and reproductive health
  • Deliver sexual and reproductive health training and professional development to those who work with young people, in particular teachers, parents/caregivers, parent educators, early childhood, kohanga reo, and kindergarten teachers, public health nurses, community workers, and Police (Keeping Ourselves Safe).
  • Deliver training and support to new providers and existing providers of sexual health services for identified populations e.g. Māori, Pacific peoples, Asian peoples, refugees and immigrants and people with disabilities.
  • Monitor and assess the effectiveness of sexual and reproductive health programmes
  • Develop evaluation and monitoring components in sexual and reproductive health services to guide programme development and assess effectiveness.
  • Use information from and support national and local surveillance systems to provide information and feedback for programme planning and evaluation.

5.7Pacific Health

The Service will understand and respect the key principles and frameworks outlined in relevant Pacific health and disability strategy documents including the Health and Disability Action Plan 2002 and demonstrate a commitment to these principles in the provision of these services.

The provider will ensure priority groups are involved in the design and delivery of general services and those targeting particular groups e.g. Pacific cultural service delivery

5.8Health for Other Ethnic Groups

The Service must take into account the particular needs of culturally diverse communities. The provider should strive to minimise barriers to access or communication and programmes must be safe for all people.

The provider will ensure that population groups being reached are involved in the design and delivery of general services and those targeting particular groups.

6.Service Linkages

Sexual Health providers are required to have linkages with the following key stakeholders and service providers:

Service Provider/stakeholder / Nature of Linkage / Accountabilities
NGOs who deliver national sexual and reproductive health promotion programmes such as Family Planning, New Zealand Prostitutes Collective, and New Zealand Aids Foundation / Collaboration / Improve the coordination and delivery of sexual health programmes, ensure consistent messages, and reduce duplication.
Primary Health Organisations (PHOs) General Practitioners and Nurse Practitioners / Collaboration / Improve the coordination and delivery of sexual health programmes, ensure consistent messages, and reduce duplication.
Other providers of personal sexual health services (DHBs, Family planning etc) / Collaboration / Improve the coordination and delivery of sexual health programmes, ensure consistent messages, and reduce duplication.
Māori and Pacific providers of sexual health services and programmes / Collaboration and support / Maintain a community development approach in programme design and implementation.
Schools’ and Boards of Trustees / Expert advise and collaboration / Assist with the development of sexual health policies and practices, which create a safe and supportive environment for students and encourage responsible and safe sexual behaviour. Support the delivery of sexuality education programmes in schools
DHB planning and Funding teams / Liaison, collaboration / Ensure programmes are consistent with DHB priorities and planning, and where appropriate regional public health plans

7.Exclusions

The Ministry of Health funds DHBs and NGOs separately, through DHB Crown Funding Agreements or separate provider contracts, for personal sexual health services, which are outside this service specification.

8.Quality Requirements

Refer to the tier one Public Health Services service specification

All providers of sexual health programmes under this service specification are required to meet the following standards and legislative requirements:

  • development of programmes and initiatives based on evidence and best-practice
  • development and implementation of programmes that are consistent with relevant key Ministry of Health strategic documents such as:

­Sexual and Reproductive Health Strategy: Phase One.[†]

­Sexual and Reproductive Health: a resource book for New Zealand Health Care organisations.[‡]

­HIV/AIDS action Plan: Sexual and Reproductive Health Strategy.[§]

  • Any other policy, quality and service standards and other requirements that may be developed, from time to time, and accepted by The Ministry of Health, in respect of the provision of sexual health programmes and initiatives.

9.Purchase Units and Reporting

Purchase Units are defined in the joint DHB and Ministry’s Nationwide Service Framework Purchase Unit Data Dictionary (PUDD). Please refer to the PUDD for purchase units that apply to this service.

9.1Reporting Requirements

All reporting requirements are detailed in the individual contracts.

Appendix OneDefinitions

Sexual health:“Sexual health is the experience of the ongoing process of physical, psychological, and socio-cultural well-being related to sexuality. Sexual health is evidenced in the free and responsible expressions of sexual capabilities that foster harmonious personal and social wellness, enriching individual and social life. It is not merely the absence of dysfunction, disease and/or infirmity. For sexual health to be attained and maintained, it is necessary that the sexual rights of all people be recognised and upheld.”[**]

Reproductive health:“is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system …. Reproductive health … implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this … are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice… and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth …”[††]

Sexually Transmitted Infections (STIs):“An infection that can be transferred from one person to another through sexual contact. In this context, sexual contact is more than just sexual intercourse (vaginal and anal) and also includes kissing, oral-genital contact, and the use of sexual "toys," such as vibrators.”[‡‡]

Sexuality education: “…a lifelong process of acquiring information and forming attitudes, beliefs, and values about such important topics as identity, relationships, and intimacy.”[§§]

Sexual orientation:“Sexual orientation is the organization of an individual’s eroticism and/or emotional attachment with reference to the sex and gender of the partner involved in sexual activity. Sexual orientation may be manifested in any one or a combination of sexual behaviour, thoughts, fantasies or desire.”[***]

Sexual identity:“Sexual identity is the overall sexual self identity which includes how the individual identifies as male, female, masculine, feminine, or some combination and the individual’s sexual orientation.

It is the internal framework, constructed over time that allows an individual to organise a self-concept based upon his/her sex, gender, and sexual orientation and to perform socially in regards to his/her perceived sexual capabilities.”[†††]

Appendix Two Service Planning Information

  • It is estimated that by 15 years of age, 32 percent of females and 28 percent of males have had penetrative sexual intercourse (Dickson et al 1998).
  • A NZ study found that 70 percent of women who had sexual intercourse before the age of 16 regretted doing so. First intercourse at younger ages is associated with risks that are shared unequally between men and women.
  • Teenage pregnancy continues to be an issue in New Zealand. The birth rate for Maori teenagers (15-19) is 69 per 1,000, which is more than double the birth rate for others aged 15-19 (32 per 1,000).[‡‡‡] While the overall birth rate (32 per 1,000) is similar to countries such as England and Wales it is much higher than other similar countries including Australia (15.4 per 1,000), Canada (13.4 per 1,000) and Denmark (5.8 per 1,000).
  • The number of abortions in 15-19 year olds increased from 21.5 per 1000 in 1998 to 27 per 1,000 in 2007. The abortion rate is highest in 20-24 year olds and increased from 34.8 per 1,000 to 37 per 1,000 in 2007.[§§§]
  • In 2001 Asian (364 per 1000), Maori (280) and Pacific women (255) had higher rates of abortion than the national average (226) and than the European rate (207).
  • A NZ study found that 43 percent of women presenting for an abortion had a family income of less than $22,000, and more than half had a community services card. Financial barriers were the reason for non-use of contraception for 32 percent of the women in this study who were not using a method.
  • Information on STIs in NZ is incomplete, as national statistics are not collected. With the exception of AIDS, STIs are not notifiable infectious diseases. However the Institute of Environmental Science and Research (ESR) collates anonymous data on STIs diagnosed at all sexual health clinics and since 1998, at FPA clinics and student health clinics. Over the period from 2002 to 2006 the number of cases of chlamydia and gonorrhoea infection diagnosed at sexual health clinics increased by 27.7% and 52.1% respectively (over the same time as a 10.5% increase in clinic visits) (ESR, 2007). In 2006, sexual health clinics also reported an increase in the number of cases of syphilis infection compared to 2005, although overall numbers remain low (ESR, 2007).
  • It is important to take note of the increasing sexually transmitted infections as they are associated with serious maternal and neonatal morbidity, preventable subfertility, anogenital cancers, and transmission of HIV[****].
  • New Zealand has much higher rates of both chlamydia and gonorrhoea infection than Australia and the UK. Chlamydia infection rates in New Zealand are two to three times higher than the UK and Australia and rates of gonorrhoea infection are three to four times higher than the UK and Australia.[††††]
  • Young people under the age of 25 years are at the highest risk of chlamydia and gonorrhoea infection (ESR, 2007). Young people, Maori and Pacific peoples are at greatest risk of concurrent infection (ESR, 2007). However, there should be caution in interpretation of these trends as they may reflect lower access to primary care services and/or lower asymptomatic “check-up” rates, rather than higher rates of disease in these populations (Ministry of Health, 2002).
  • In New Zealand the prevalence of HIV infection in the general population is very low. The main risk for acquiring HIV infection in New Zealand is still among men who have sex with men. The number of people diagnosed with HIV peaked in 2005 (183 people), decreased in the following two years of 2006 (177) and 2007 (156) and then has risen again in 2008 (184) to the highest number diagnosed since data collection commenced in 1985.[‡‡‡‡]
  • The number of men who have sex with men diagnosed with HIV has seen a similar pattern of peaking in 2005, dropping off slightly and then increasing again in 2008. The number of men and women heterosexually infected with HIV has decreased slightly from the peak year in 2006. The majority of men who have sex with men are thought to have been infected in New Zealand whereas the majority of people heterosexually infected are thought to have been infected overseas.[§§§§]
  • To the end of December 2008, a total of 3099 people have been reported to be infected with HIV in New Zealand and 997 people notified as having AIDS.[*****]

Appendix Three References