This landmark study on the cost and cost-effectiveness of school-based sexuality education looks at a range of programmes across low-, middle- and high-income countries, including Estonia, India, Indonesia, Kenya, the Netherlands and Nigeria. Though programmes vary widely in terms of design and scale, it is clear that integrated mandatory programmes are more efficient, as are those adapted from existing models. The costs per learner receiving the curriculum in scaled-up, well established programmes range from US$ 6.90 in Nigeria to US$ 32.80 in the Netherlands. Smaller pilot programmes in Kenya and Indonesia indicate significantly higher costs.
The study highlights the cost-effectiveness, and potential cost savings in a context like Estonia, where a national sexuality education programme was rolled out alongside youth-friendly sexual and reproductive health services. Between 2001 and 2009, an estimated 13,490 health events were averted, including 1,970 HIV infections, at a potential lifetime cost of US$67,825 per patient.