Governance and Implementation Gaps in Adolescent Sexual and Reproductive Health Education and Services: Perspectives of Adolescent Girls and Policy Implementers in Tiko Health District, Southwest Cameroon

The strive toward achieving adolescent girls' sexual and reproductive health empowerment (SRHE) cannot be without challenges.The study examined governance and implementation gaps in establishing effective operational mechanisms that enhance and sustain adolescent girls' SRHE.The study obtained ethical approval and used a concurrent triangulation and sequential exploratory mixed-methods design, combining quantitative and qualitative approaches within a survey framework.A total of 395 participants took part in the study, comprising 384 adolescent girls and 11 key informants from the traditional, educational, health, social, legal, women and gender empowerment, and NGO's sectors.We analyzed quantitative data using SPSS, while we conducted thematic analysis of qualitative data using ATLAS.tiand NVivo.The findings revealed breaches in adolescent girls' SRHE, ranging from early indulgent sex, transactional sex, unintended pregnancy, school dropout, unsafe abortion, and low perception of contraceptives, with a preference for condoms.Although the socio-political crisis contributed through poverty, displacement, and family disruption, other salient facilitators included inadequate policies and governance, with the education sector still lacking structure and specificity.To improve and sustain adolescent girls' SRHE, stakeholders suggested the refinement of SRH education, notably in secondary school, and the proper structuring and implementation of policies in a multi-sectoral approach while striving to end the socio-political crisis, alleviating poverty and fostering early home-based education, comprehensive / intensified school-based education with effective integration into the curriculum, intensified community-based education and awareness, and controlled information through mass and social media, while intensifying education from early adolescence.The T-SAG-SRHE Model (Tiko-Sexual and Reproductive Health Empowerment of Adolescent Girls Model) is introduced as a context-responsive framework designed to address policy and implementation gaps in adolescent sexual and reproductive health education and services within the Tiko Health District and comparable contexts