Single outcome agreements and HIV
In November 2007 the Scottish Government and the Convention of Scottish Local Authorities (CoSLA) introduced an outcomes approach to public service management and accountability. Instead of focusing on how budgets are spent and what was done, an outcomes approach shifts attention to the impact on service users and progress towards improved population level outcomes.
Individual single outcome agreements (SOAs) were therefore developed for all 32 of Scotland's local authorities. They set out how each should work towards improving outcomes for the local people in a way that reflects local circumstances and priorities.
This established single outcome agreements as the main framework for aligning public sector activity towards agreed priorities.
A review of single outcome agreements in Scotland
Of the single outcome agreements of Scotland’s local authorities, 14 refer to sexual health. Of these, four refer to HIV and one refers to blood borne viruses. In comparison, 20 refer to teenage pregnancy, or to pregnancies in mothers under 16 or under 18.
While the rate of teenage pregnancy is often mentioned as an outcome, target, or indicator, this is not the case for sexual health. Most mentions of sexual health, within the 14 single outcome agreements where they appear, are in terms of current approaches, commitments to continuing current strategies, or priorities and ambitions. One exception, in the Highland agreement, is the identification of age and stage appropriate sexual health and relationships education being delivered to all pupils as an intermediate outcome, along with increasing the confidence and skills of staff to deliver this education.
Many of the references to sexual health are in relation to reducing health inequalities. For example, Dundee's single outcome agreement discusses current and continuing approaches to sexual health as part of tackling health inequalities. This includes peer-led sexual health and relationships education and programs encouraging parents to talk to their children about sexual health.
References to sexual health also occur in sections on giving children and young people the best start in life. For instance, Edinburgh’s agreement identifies lessening or removing the impacts of unsafe sex and unintended pregnancy as part of improving health outcomes for children. Comhairle nan Eilean Siar’s single outcome agreement mentions sexual health among the Curriculum for Excellence programs that ensure the best start in life for children and young people.
At times, sexual health is referred to in relation to promoting healthier citizens. Moray Council’s agreement references sexual health and blood borne viruses as priorities to be addressed in achieving the outcome of healthier citizens, noting rising sexually transmitted infections coupled with worsening awareness among school aged children as a particular issue.