Japan Health Policy NOW | Niigata Prefecture – Health Center Activities: Case Study 1

Kashiwazaki Health Center

Background

This project has been implemented continuously for more than 15 years. Since 2013, information exchange meetings have been held as part of the “Project on establishing continuous support systems around pregnancy” (referred as meeting). The meeting was initiated to discuss the way forward based on current issues. Participants include doctors, midwives from midwives’ associations, nurse-teachers, public health nurses/midwives from municipal childcare support centers, municipal contact points for boards of education, village maternal health managers, and public health nurses from health centers. They discussed issues including continuous preventive education for adolescents, establishing post-partem support systems and for women experiencing artificial abortions. As a result, information exchange meeting members confirmed the necessity of strengthening school support systems and preventative education in efforts to provide continuous preventative education to adolescents. These efforts are being implemented within adolescent sexual education meetings.

Overview of activities

■ Lectures on adolescent sexual health

Target	All 8 prefectural high schools and special support schools managed by the Kashiwazaki Health Center. Most schools target first or second year students All of the 13 public junior high schools have also been targeted since FY2017, although only some were targeted in FY2016 and previous years. Lectures are offered in response to requests sent by schools. In FY2017, lectures were implemented in 10 schools For elementary schools, lectures are conducted independently
Lecturer	Obstetrician/ gynecologists and midwives from among the members of the information exchange meeting, as well as public health nurses from health centers
Budget	Funding is provided by the prefectural Government for high schools, and by municipal boards of education for junior high schools. Elementary schools fund lectures themselves
Frequency	Once a year
Overview	The subjects depend on schools and target grades, but mainly include AIDS/STD prevention, the image that students have about sexuality, mechanisms of pregnancy and contraception, menstruation/premenstrual syndrome (PMS) and control measures, and information on where to seek advice A questionnaire was conducted before and after lectures were carried out in FY2017, as suggested by information exchange meeting members. Students were asked about their image and knowledge of sexuality, actions they could take to avoided STDs and unwanted pregnancies, and how to ask someone for support when needed. The results are currently being analyzed at health centers, but some positive changes have been recognized in levels of knowledge as well as images related to sexuality
Special Features of the Program	Provide practical information such as community data, real case examples, and contact details related to consultations As there was a reported need for sexual education from a male point of view, the project sent a male obstetrician to schools with a high proportion of boy students

Strengths of the Initiative

Collaboration among different professionals
- The information sharing meetings enable lecturers, health centers and schools to share common grounds and continue the project effectively.

Current Issues of the Initiative

Project evaluation
- Indices to measures mid- to long-term impacts. (comment from Health Center)
Selection of lecture methods and target audience
- Effective indices in light of the actual situation of students as understood through the pre- and post-lecture surveys. (comment from Health Center)
- The issue of how to provide lectures at special needs schools and involve parents effectively. (comment from a Lecturer)

Direction for Future Development

Continue the project
- Create a sustainable system to deploy external lecturers. (comment from Health Center)
Provide opportunities for individual support
- Examine and identify approaches where guidance is provided in response to individual needs, in consideration of current issues, including increasing diversity in the way people express their sexuality and the way that young people live. (comment from Lecturer)

Expectations for other stakeholders

Government
- It is hoped that the national Government will secure a budget for sexual education and continue its active engagement on this issue. (comments from both Health Center and Lecturer)
External lecturers
- Guidance should be given according to the needs of students and actual situation in each community. (comment from Health Center)

Interviewees

Health Center
- Community Health Division, Health and Welfare Department, Kashiwazaki Regional Promotion Bureau, Niigata Prefecture
Lecturer (Adolescent Sex Education Lecturer)
- Ms. Naomi Ishiguro, Midwife, Yuiku Maternity Home

Interview date: December 2017

Health Center Activities

Niigata Prefecture

Providing sexual and reproductive health education (AIDS/STD Prevention) through a community- and needs-based approach led by health centers