Scaling up Adolescent Sexual and Reproductive Health Interventions Through Existing Government Systems? A Detailed Process Evaluation of a School-Based Intervention in Mwanza Region in the Northwest of Tanzania

High coverage of participatory school-based reproductive health interventions can be maintained during scale-up. However, this is likely to be associated with significant changes in programme content and delivery. A greater emphasis should be placed on improving teachers' capacity to teach more complex-skills-related activities. Future intervention scale-up should also include an increased level of supervision and may be strengthened by underpinning from national level directives and inclusion of behavioral topics in national examinations.