on behalf of all DHBs
PUBLIC HEALTH SERVICES SEXUAL HEALTH PROMOTION SERVICES
TIER LEVEL TWO
SERVICE SPECIFICATION
Status:
FINAL
Approved for recommended nationwide use for the
non-mandatory description of services funded by
DHBs.
RECOMMENDED 
Status:
Approved for mandatory nationwide use for the
description of services to be funded by the Ministry
of Health.
Review History
MANDATORY 
Date
Approved by Nationwide Service Framework
Coordinating Group (NCG)
Published on NSFL
Review :Public Health Handbook (2003) Amendments:
use of standards service specification template, update of
background (statistics), editing and wording changes relating to
change in delivery emphasis, addition of sections on definitions,
quality, Service users, purchase units, linkages, and exclusions.
Consideration for next Service Specification
Review
April 2010
Within three years
Note: Contact the Service Specification Programme Manager, National Health Board Business
Unit, Ministry of Health to discuss the process and guidance available in developing new or
updating and revising existing service specifications. Web site address of the Nationwide Service
Framework Library: http://www.nsfl.health.govt.nz/
PUBLIC HEALTH SERVICES SEXUAL HEALTH PROMOTION SERVICES
TIER LEVEL TWO
SERVICE SPECIFICATION
This tier two service specification for Public Health Services - Sexual Health Promotion
Services (the Service), must be used in conjunction with the overarching tier one Public
Health Services Specification.
Refer to the tier one Public Health Services service specification for details under the
following headings fro generic details on:







Service Objectives
Service Users
Access
Service Components
Service Linkages
Exclusions
Quality Requirements
The above heading sections are applicable to all service delivery.
1.
Service Definition
Sexual health is the experience of the ongoing process of physical, psychological, and
socio-cultural well-being related to sexuality. Sexual health is evidenced in the free and
responsible expressions of sexual capabilities that foster harmonious personal and social
wellness, enriching individual and social life.
Reproductive health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity, in all matters relating to the reproductive
system.
This Service relates to the Public Health Services health promotion programmes that
contribute to the improvement of sexual and reproductive health and wellbeing.
For definitions of sexual health related terms used in this document see Appendix One.
2.
Service Objectives
2.1 General
The Service objectives are to:

improve the sexual and reproductive health status of New Zealanders, including:
- delayed onset of sexual activity amongst young people
- improved access to contraceptive information
- reduced rates of unintended pregnancy
- reduced transmission of STIs including HIV infection
- reduced rates of abortion

reduce inequalities in sexual and reproductive health status (including between
Māori and other New Zealanders) and:
- provide support for the development of sexual and reproductive health services
Public Health Services - Sexual Health Promotion Services tier two service specification, April 2010
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delivered by Māori for Māori
- improve mainstream service responsiveness to Māori
- provide a more supportive social environment which acknowledges differences
in sexual orientations.

support the development of healthy public policy in relation to sexual and
reproductive health.

assist in the development of supportive school environments for the sexual health of
adolescents. This will include supporting programme and policy development in
schools towards realistic, comprehensive sexuality education programmes for
adolescents

provide sexuality training to professionals, parents, caregivers, and tertiary students

deliver targeted sexual health education services to those at high risk from STIs
including HIV/AIDS, including men who have sex with men, and sex workers.
2.2 Māori Health
Refer to the tier one Public Health service specification.
3.
Service Users
Service users for sexual health programmes include all New Zealanders. However,
providers should focus on effective and available sexual health services and programmes
for Māori, Pacific peoples, young people, people with disabilities, men who have sex with
men, and sex workers.
Increasing the ability of families and caregivers to support their children and young
peoples to make healthy sexual and reproductive health decisions is also a priority.
4.
Access
Access to sexual health promotion programmes is for all New Zealanders, but with an
emphasis on effective and available services for Māori, Pacific peoples, young people,
people with disabilities, men who have sex with men, and sex workers.
5.
Service Components
5.1 Contribute to the development of policies and social environments, that
support improved sexual and reproductive health status

Provide evidence-based input to policy development processes at national, regional
and local levels, where this input can contribute to a social environment conducive to
responsible and safe sexual behaviour.

Assist schools and Boards of Trustees with the development of sexual health policies
and practices, which create a safe and supportive environment for students and
encourage responsible and safe sexual behaviour.

Promote strategies at a national, regional and local level which support improved
sexual and reproductive health status.
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5.2 Support youth development and community action approaches promoting
sexual and reproductive health

Facilitate and manage the development and implementation of evidence-based
community and school-based sexual and reproductive health programmes. Ensure
approaches are consistent with The Youth Development Strategy Aotearoa.*
5.3 Increase community awareness about sexual and reproductive health issues

Develop and deliver evidence-based public awareness campaigns in response to
identified sexual and reproductive health issues, where appropriate. This will include
accurate information on STIs (including HIV/AIDS) and their modes of transmission,
safer sexual practices including condom use, contraceptive use, and alternatives to
penetrative sexual intercourse including delaying onset of sexual activity, both
delivered to the general population and targeted to those at high risk of STI infection.

Develop, produce and distribute sexual and reproductive health education resources,
including newsletters, brochures, teaching kits and fact sheets, which support public
health programme delivery and referral information. Any development of new
resources or revision of old resources should first be approved by the Ministry of
Health. New resources need to comply with Ministry of Health guidelines and
standards on resource development.

Contribute to and organise community forums, education sessions and workshops on
sexual and reproductive health.

Support the delivery of sexuality education programmes to schools that promote the
development of healthy sexuality, and acknowledge and are inclusive of differences
in sexual orientation. Sexuality education programmes should take account of the
following nine criteria for effectiveness:
- focus on identified behavioural goals, e.g., delaying initiation of intercourse or
using contraception
- based on theoretical approaches which have been demonstrated to be effective
in influencing other health-related risk behaviour – e.g., social cognitive theory,
social influence theory, social inoculation theory, cognitive behavioural theory
- behavioural goals, teaching methods and materials appropriate to the age,
sexual experience and culture of students
- ideally, programmes should last 14 or more hours in total. Where this is not
possible, programmes lasting a smaller number of hours should be implemented
in small group settings with a leader for each group, and reinforce risk behaviour
goals from other topic areas such as tobacco, alcohol and drugs
- teaching methods should involve the participants and enable them to
personalise the information
- basic, accurate information should be provided about the risks of unprotected
sexual contact and methods of avoiding unprotected sexual contact
- programmes should include activities that address social pressures on sexual
behaviours
- programmes should provide modelling and practice of communication,
*
Ministry of Youth Affairs The Youth Development Strategy Aotearoa Wellington: Ministry of Youth Affairs,
2002
4
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negotiation and refusal skills
- teachers or peers who believe in the programme and are well trained should
deliver the programme.
5.4 Strengthen strategic alliances and interagency networks to promote sexual and
reproductive health

Work collaboratively with other sexual and reproductive health promotion providers to
promote and support related community-based programmes developed by other
agencies.

Provide training services, resources and assistance to Māori providers of sexual
health services as requested by Māori.

Develop formal relationships with other providers and representatives of other sectors
where this will improve the coordination and delivery of sexual and reproductive
health services.

Maintain good working relationships with key personal health providers to ensure the
best possible sexual and reproductive health outcomes.
5.5 Strengthen skills and knowledge of the health sector and other change agents
to promote sexual and reproductive health

Deliver sexual and reproductive health training and professional development to
those who work with young people, in particular teachers, parents/caregivers, parent
educators, early childhood, kohanga reo, and kindergarten teachers, public health
nurses, community workers, and Police (Keeping Ourselves Safe).

Deliver training and support to new providers and existing providers of sexual health
services for identified populations e.g. Māori, Pacific peoples, Asian peoples,
refugees and immigrants and people with disabilities.
5.6 Monitor and assess the effectiveness of sexual and reproductive health
programmes

Develop evaluation and monitoring components in sexual and reproductive health
services to guide programme development and assess effectiveness.

Use information from and support national and local surveillance systems to provide
information and feedback for programme planning and evaluation.
5.7 Pacific Health
The Service will understand and respect the key principles and frameworks outlined in
relevant Pacific health and disability strategy documents including the Health and Disability
Action Plan 2002 and demonstrate a commitment to these principles in the provision of
these services.
The provider will ensure priority groups are involved in the design and delivery of general
services and those targeting particular groups e.g. Pacific cultural service delivery
5.8 Health for Other Ethnic Groups
The Service must take into account the particular needs of culturally diverse communities.
The provider should strive to minimise barriers to access or communication and
programmes must be safe for all people.
The provider will ensure that population groups being reached are involved in the design
and delivery of general services and those targeting particular groups.
Public Health Services - Sexual Health Promotion Services tier two service specification, April 2010
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6.
Service Linkages
Sexual Health providers are required to have linkages with the following key stakeholders
and service providers:
Service
Provider/stakeholder
NGOs who deliver national
sexual and reproductive
health promotion
programmes such as Family
Planning, New Zealand
Prostitutes Collective, and
New Zealand Aids
Foundation
Primary Health
Organisations (PHOs)
General Practitioners and
Nurse Practitioners
Other providers of personal
sexual health services
(DHBs, Family planning etc)
Nature of
Linkage
Collaboration
Accountabilities
Collaboration
Māori and Pacific providers
of sexual health services and
programmes
Schools’ and Boards of
Trustees
Collaboration
and support
DHB planning and Funding
teams
Liaison,
collaboration
Improve the coordination and delivery
of sexual health programmes, ensure
consistent messages, and reduce
duplication.
Improve the coordination and delivery
of sexual health programmes, ensure
consistent messages, and reduce
duplication.
Maintain a community development
approach in programme design and
implementation.
Assist with the development of sexual
health policies and practices, which
create a safe and supportive
environment for students and
encourage responsible and safe
sexual behaviour. Support the delivery
of sexuality education programmes in
schools
Ensure programmes are consistent
with DHB priorities and planning, and
where appropriate regional public
health plans
7.
Collaboration
Expert advise
and
collaboration
Improve the coordination and delivery
of sexual health programmes, ensure
consistent messages, and reduce
duplication.
Exclusions
The Ministry of Health funds DHBs and NGOs separately, through DHB Crown Funding
Agreements or separate provider contracts, for personal sexual health services, which are
outside this service specification.
8.
Quality Requirements
The Service must comply with the Provider Quality Standards described in the Operational
Policy Framework or, as applicable, Crown Funding Agreement Variations, contracts or
service level agreements.
All providers of sexual health programmes under this service specification are required to
meet the following standards and legislative requirements:

development of programmes and initiatives based on evidence and best-practice
Public Health Services - Sexual Health Promotion Services tier two service specification, April 2010
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6

development and implementation of programmes that are consistent with relevant
key Ministry of Health strategic documents such as:
-
Sexual and Reproductive Health Strategy: Phase One.†
Sexual and Reproductive Health: a resource book for New Zealand Health Care
organisations.‡
HIV/AIDS action Plan: Sexual and Reproductive Health Strategy. §

Any other policy, quality and service standards and other requirements that may be
developed, from time to time, and accepted by The Ministry of Health, in respect of
the provision of sexual health programmes and initiatives.
9.
Purchase Units and Reporting
Purchase Units are defined in the joint DHB and Ministry’s Nationwide Service Framework
Purchase Unit Data Dictionary. The following Purchase Units apply to this Service:
PU Code
Purchase
Unit Code
Description
PU Definition
Unit of
Measure
Unit of Measure
Definition
RM00109
STIs including
HIV/AIDS
Sexually transmitted
diseases including
HIV/AIDS.
Service
Service purchased in
a block arrangement
uniquely agreed at a
local level.
National
Collections or
payment
systems
National Nonadmitted Patient
Collection
(NNPAC)
9.1 Reporting Requirements
All reporting requirements are detailed in the individual contracts.
†
Minister of Health. Sexual and Reproductive Health Strategy: Phase One. Wellington: Ministry of Health,
2001
‡ Ministry of Health Sexual and Reproductive Health: a resource book for New Zealand Health Care
organisations Wellington: Ministry of Health, 2003
§ Ministry of Health HIV/AIDS Action Plan: Sexual and Reproductive Health Strategy.Wellington: Ministry of
Health, 2003
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Appendix One Definitions
Sexual health: “Sexual health is the experience of the ongoing process of physical,
psychological, and socio-cultural well-being related to sexuality. Sexual health is
evidenced in the free and responsible expressions of sexual capabilities that foster
harmonious personal and social wellness, enriching individual and social life. It is not
merely the absence of dysfunction, disease and/or infirmity. For sexual health to be
attained and maintained, it is necessary that the sexual rights of all people be recognised
and upheld.”**
Reproductive health: “is a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity, in all matters relating to the reproductive
system …. Reproductive health … implies that people are able to have a satisfying and
safe sex life and that they have the capability to reproduce and the freedom to decide if,
when and how often to do so. Implicit in this … are the right of men and women to be
informed and to have access to safe, effective, affordable and acceptable methods of
family planning of their choice… and the right of access to appropriate health-care
services that will enable women to go safely through pregnancy and childbirth …”††
Sexually Transmitted Infections (STIs):“An infection that can be transferred from one
person to another through sexual contact. In this context, sexual contact is more than just
sexual intercourse (vaginal and anal) and also includes kissing, oral-genital contact, and
the use of sexual "toys," such as vibrators.”‡‡
Sexuality education: “…a lifelong process of acquiring information and forming attitudes,
beliefs, and values about such important topics as identity, relationships, and intimacy.” §§
Sexual orientation: “Sexual orientation is the organization of an individual’s eroticism
and/or emotional attachment with reference to the sex and gender of the partner involved
in sexual activity. Sexual orientation may be manifested in any one or a combination of
sexual behaviour, thoughts, fantasies or desire.”***
Sexual identity: “Sexual identity is the overall sexual self identity which includes how the
individual identifies as male, female, masculine, feminine, or some combination and the
individual’s sexual orientation.
It is the internal framework, constructed over time that allows an individual to organise
a self-concept based upon his/her sex, gender, and sexual orientation and to perform
socially in regards to his/her perceived sexual capabilities.”†††
**
The Pan American Health Organisation and World Health Organisation. 2000. Promotion of Sexual
Health: Recommendations for Action Guatemala: The Pan American Health Organisation and World
Health Organisation
†† See WHO website: http://www.who.int/reproductive-health/publications/strategy.pdf
‡‡ The Pan American Health Organisation and World Health Organisation. 2000. Promotion of Sexual Health:
Recommendations for Action Guatemala: The Pan American Health Organisation and World Health
Organisation
§§ As defined by the Sexuality Information and Education Council of the United States (SIECUS). Website
http://www.siecus.org
*** The Pan American Health Organisation and World Health Organisation. 2000. Promotion of Sexual Health:
Recommendations for Action Guatemala: The Pan American Health Organisation and World Health
Organisation
††† Ibid
8
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Appendix Two Service Planning Information

It is estimated that by 15 years of age, 32 percent of females and 28 percent of males
have had penetrative sexual intercourse (Dickson et al 1998).

A NZ study found that 70 percent of women who had sexual intercourse before the
age of 16 regretted doing so. First intercourse at younger ages is associated with
risks that are shared unequally between men and women.

Teenage pregnancy continues to be an issue in New Zealand. The birth rate for
Maori teenagers (15-19) is 69 per 1,000, which is more than double the birth rate for
others aged 15-19 (32 per 1,000).‡‡‡ While the overall birth rate (32 per 1,000) is
similar to countries such as England and Wales it is much higher than other similar
countries including Australia (15.4 per 1,000), Canada (13.4 per 1,000) and Denmark
(5.8 per 1,000).

The number of abortions in 15-19 year olds increased from 21.5 per 1000 in 1998 to
27 per 1,000 in 2007. The abortion rate is highest in 20-24 year olds and increased
from 34.8 per 1,000 to 37 per 1,000 in 2007.§§§

In 2001 Asian (364 per 1000), Maori (280) and Pacific women (255) had higher rates
of abortion than the national average (226) and than the European rate (207).

A NZ study found that 43 percent of women presenting for an abortion had a family
income of less than $22,000, and more than half had a community services card.
Financial barriers were the reason for non-use of contraception for 32 percent of the
women in this study who were not using a method.

Information on STIs in NZ is incomplete, as national statistics are not collected. With
the exception of AIDS, STIs are not notifiable infectious diseases. However the
Institute of Environmental Science and Research (ESR) collates anonymous data on
STIs diagnosed at all sexual health clinics and since 1998, at FPA clinics and student
health clinics. Over the period from 2002 to 2006 the number of cases of chlamydia
and gonorrhoea infection diagnosed at sexual health clinics increased by 27.7% and
52.1% respectively (over the same time as a 10.5% increase in clinic visits) (ESR,
2007). In 2006, sexual health clinics also reported an increase in the number of cases
of syphilis infection compared to 2005, although overall numbers remain low (ESR,
2007).

It is important to take note of the increasing sexually transmitted infections as they
are associated with serious maternal and neonatal morbidity, preventable subfertility,
anogenital cancers, and transmission of HIV****.

New Zealand has much higher rates of both chlamydia and gonorrhoea infection than
Australia and the UK. Chlamydia infection rates in New Zealand are two to three
times higher than the UK and Australia and rates of gonorrhoea infection are three to
four times higher than the UK and Australia.††††

Young people under the age of 25 years are at the highest risk of chlamydia and
gonorrhoea infection (ESR, 2007). Young people, Maori and Pacific peoples are at
‡‡‡
Statistics New Zealand, Demographic Trends 2007, Statistics New Zealand, Wellington January 2008
Statistics New Zealand, Demographic Trends 2007, Statistics New Zealand, Wellington January 2008
****
Morgan J. Testing and detection trends of Chlamydia trachomatis and Neisseria gonorrhoea in Waikato,
New Zealand: 1998–2006, NZMJ 25 July 2008, Vol 121 No 1278.
†††† Institute of Environmental Science and Research Limited (ESR) Sexually Transmitted Infections in New
Zealand, Annual Surveillance Report 2007, Published April 2008.
9
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§§§
greatest risk of concurrent infection (ESR, 2007). However, there should be caution
in interpretation of these trends as they may reflect lower access to primary care
services and/or lower asymptomatic “check-up” rates, rather than higher rates of
disease in these populations (Ministry of Health, 2002).

In New Zealand the prevalence of HIV infection in the general population is very low.
The main risk for acquiring HIV infection in New Zealand is still among men who have
sex with men. The number of people diagnosed with HIV peaked in 2005 (183
people), decreased in the following two years of 2006 (177) and 2007 (156) and then
has risen again in 2008 (184) to the highest number diagnosed since data collection
commenced in 1985.‡‡‡‡

The number of men who have sex with men diagnosed with HIV has seen a similar
pattern of peaking in 2005, dropping off slightly and then increasing again in 2008.
The number of men and women heterosexually infected with HIV has decreased
slightly from the peak year in 2006. The majority of men who have sex with men are
thought to have been infected in New Zealand whereas the majority of people
heterosexually infected are thought to have been infected overseas. §§§§

To the end of December 2008, a total of 3099 people have been reported to be
infected with HIV in New Zealand and 997 people notified as having AIDS.*****
‡‡‡‡
Information from the AIDS Epidemiology Group used to prepare statement.
Information from the AIDS Epidemiology Group used to prepare statement.
***** Information from the AIDS Epidemiology Group used to prepare statement.
Public Health Services - Sexual Health Promotion Services tier two service specification, April 2010
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§§§§
10
Appendix Three References
AIDS Epidemiology Group. February 2003. Issue 51, AIDS New Zealand fact sheet. Dunedin:
University of Otago.
Asiasiga, L. 1994. Abortion and Pacific Islands Women: A Pilot Study for the New Zealand Family
Planning Association.
Cheesbrough S, Ingham R, Massey D. 1999. A review of the international evidence on preventing
and reducing teenage conceptions: The United States, Canada, Australia and New Zealand.
London: Health Education Authority.
Dickson N. 1996. Sexual Behaviour. In: Silva and Stanton (eds). From Child to Adult: the Dunedin
Multidisciplinary Health and Development Study (chpt 13). Dunedin: Oxford University Press.
Dickson N. 1998. Pregnancies among New Zealand teenagers: trends, current status and
international comparisons. Dunedin: University of Otago Medical School.
Dickson N, Paul C, Herbison P, Silva P. 1998. First sexual intercourse: age, coercion, and later
regrets reported by a birth cohort. Brit Med J; 316:29-33.
Institute of Environmental Science and research Limited (ESR). 2007. Sexually Transmitted
Infections in New Zealand. Annual surveillance Report 2006 ESR
Family Planning Association. 1997. Key Trends in Fertility, Pregnancy and Abortion in New
Zealand. (Fact sheet using figures provided by the Population and Demographic Division of
Statistics New Zealand). Wellington: Family Planning Association.
Innocenti Report Card, Issue No. 3: A League table of Teenage Births in Rich Nations. Innocenti
Research Centre, Unicef 2001.
Kirby D. 1997. No Easy Answers: Research Findings on Programs to Reduce Teen Pregnancy,
National Campaign to Prevent Teen Pregnancy. Washington DC: Task Force on Effective
Programmes and Research.
Lyttle PH. 1994. Surveillance Report: Disease trends at New Zealand Sexually Transmitted
Disease Clinics 1977-1993. Genitourinary Medicine; 70: 329-35.
Ministry of Health. Prevention and Control of Sexually Transmitted Disease: a discussion
document. Wellington: Ministry of Health.
Ministry of Health. 1996. Rangatahi Sexual Wellbeing and Reproductive Health: a Discussion
Document. Wellington: Ministry of Health.
Ministry of Health. 1997. Sexually Transmitted Diseases: prevention and control. The Public Health
Issues 1996-1997. Wellington: Ministry of Health.
Ministry of Health. 2001. Sexual and Reproductive Health Strategy, Phase One. Wellington.
Ministry of Health.
Ministry of Health. 2002. New Zealand Youth health Status Report Wellington: Ministry of Health
Ministry of Health, 2003. Achieving Health for All People: Whakatutuki te oranga hauora mo nga
tangata katoa. A framework for public health action for the New Zealand Health Strategy
Skegg K, Nada-Raja S, Dickson N, Paul C, Williams S. Sexual Orientation and Self-Harm in Men
and Women. American Journal of Psychiatry 160:3, March 2003.
Statistics New Zealand 2002. Abortions year ending December 2001.
Young LK, Farquhar CM, McCowan LM, et al. 1994. The contraceptive practices of women
seeking termination of pregnancy in an Auckland clinic. NZ Med J; 107: 189-92.
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