The ‘Teachers Diploma Program’ in Zambian Government Schools: A Baseline Qualitative Assessment of Teachers’ and Students’ Strengths and Challenges in the Context of a School-Based Psychosocial Support Program

In Zambia, as elsewhere throughout sub-Saharan Africa, orphaned and vulnerable children (OVC) face multiple physical, emotional, social and psychological challenges which often negatively affect opportunities for educational attainment. REPSSI (Regional Psychosocial Support Initiative), in collaboration with, the University of Cape Town and other African academic institutions, developed the Teachers’ Diploma Program as part of the Mainstreaming Psychosocial Care and Support into Education Systems to provide teachers and school administrators with the knowledge and skills to provide needed support to students and enhance their learning environments. During initial implementation of the Teachers’ Diploma Program in Zambia (2013-2016), qualitative data was collected as a part of larger outcomes and process evaluation. In the current paper, these qualitative data are presented to describe baseline challenges and strengths within the Zambian government school system and early indicators of change during the first ten months of program implementation. These in-depth data provide both teachers’ and students’ experiences and perspectives and are being utilized to further strengthen the Teachers’ Diploma Program as the Zambian Ministry of Education, Science, Vocational Training and Early Childhood moves forward with plans to implement the training at a national level in colleges of teacher education.


Orphaned and Vulnerable Children and Education
Globally, tens of millions of children have been orphaned and/or are vulnerable due to HIV and AIDS, social and economic challenges, natural disasters, forced migration, civil unrest, and wars (Kaljee & Stanton, 2015).As a result of HIV and AIDS alone, approximately 700,000 children are orphaned and vulnerable in Zambia.(AVERT, 2012) Orphaned and vulnerable children (OVC) experience poverty, stigma and discrimination, abuse, psychological distress, and increased risk of chronic and infectious diseases.(Skinner et al., 2006;Oettgen & Mathur, 2015;Kirkpatrick, Rojjanasrirat, South, Sindt, & Williams, 2012;Zhao et al., 2009;Chi & Li 2013;Pascoe et al., 2010;Birdthistle et al., 2008) OVC frequently drop out of school or have intermittent attendance.Factors associated with school attendance and other educational indicators in Africa include food-insecurity, violence and sexual abuse, corporal punishment, caring for sick relatives, teenage pregnancy and early marriage.(Kunnuji & Esiet, 2015;Devries et al., 2013;Zhang et al., 2009;Marston, Beguy, Kabiru, & Cleland, 2013) In Zambia, between 2008-2013 primary school net attendance ratios were 71% for males and 72% for females.However, in this same time period, secondary school net attendance ratios were much lower at 47% and 44% respectively.(UNICEF, 2015)

Psychosocial Support Programs
Psychosocial support addresses physical, educational, health, emotional, spiritual, and social needs and builds internal and external resources to help children and their families cope with adversity.Evidence indicates that negative outcomes among OVC can be ameliorated through the enhancement of protective factors with the implementation of policies and programs designed to increase resilience and access to healthcare, education, and psychosocial support networks.(Lee et al., 2014;Wang et al., 2012;Smith et al., 2012;Hong et al., 2010) In recent years, a number of family-based and economic incentive programs have been developed to address the psychosocial needs of children and improve school attendance rates in sub-Saharan Africa.Indicators suggest that these programs can have a positive impact on both participants' psychological and physical well-being and their educational attainment (Sewamala et al., 2016;Eloff et al., 2014;Cho et al., 2011).

The Mainstreaming Psychosocial Care and Support into Education Systems: Teachers' Diploma Program
In 2004, REPSSI (Regional Psychosocial Support Initiative) in collaboration with UNICEF and African academicians, developed a situated, supported, distance learning community certificate program for community-based workers involved with youth.REPSSI defines psychosocial as the relationship, influence and interaction between psychological and social aspects of individuals' lives.The psychological components include cognitive, emotional and spiritual factors while the social components include interpersonal relationships and the broader social environment.
The community certificate program was situated in the participants' communities of practice, supported through regular participant meetings, and accredited through local universities.The program was designed to address the challenges for professional education in many low-and middle-income countries where travel to a central institution is an economic and social burden for adult learners and their families.Among participants in the community certificate program were teachers from Lesotho, Swaziland, Zimbabwe, and Malawi.
To date, there have been limited programs which focus on the school and classroom as a space to provide psychosocial support through teachers and school administrators.With increasing demand for the community certificate program from teachers, REPSSI, in collaboration with the University of Cape Town created a similar course focused on providing teachers with knowledge and skills to support the psychosocial needs of their students.The resulting 15-month 'Mainstreaming Psychosocial Care and Support into Education Systems: Teachers' Diploma Program' [hereafter referred to as Teachers' Diploma Program] was founded on the following tenets: 1) teachers can increase their students' psychosocial well-being if they themselves have psychosocial awareness and engage in self-care; 2) all students have strengths and challenges.By understanding these strengths and challenges, teachers can more effectively promote learning; 3) the entire school contributes to the well-being of teachers and students.This includes the way teachers teach, the arrangement of the physical environment (classrooms and schools), and relationships within the school (administrators, teachers, students, caregivers); and, 4) success is dependent on a child-centered approach with the school actively engaged with community partners from multiple circles of support (Figure 1).The course includes six modules which cover a range of topics including: 1) concepts of psychosocial support; 2) enriching and creating a safe school environment; 3) gender equity; 4) classroom management; 5) addressing bullying and sexual harassment; and 6) sharing new knowledge and skills with peers and developing school-family and school-community relations.Like the community certificate program, the Teachers' Diploma Program utilizes a situated supported long-distance learning approach.Teachers review the modules independently and meet once a month in Community of Practice sessions.The Community of Practice sessions are held within school districts and provide the teachers an opportunity to discuss the module content with their peers and identify ways in which the content can be translated into action and implemented within their school settings.Each module has a series of assignments that are marked by Zambian Teachers' College staff.In addition, three times during the program, teachers meet in a four-day residential setting to learn from Teachers' College staff and to take assessment exams.

Quantitative Evaluation of the Teachers' Diploma Program
Between 2013 and 2016, 1000 Zambian teachers were enrolled in the Teachers' Diploma Program in six districts in Western, Eastern, and Lusaka Provinces.Interested schools needed to enroll a minimum of two teachers on the course.As a part of this roll-out, both process and outcome evaluations were conducted in two provinces (Eastern and Lusaka) by an interdisciplinary multi-national research team including the University of Zambia, RuralNet Associates (a Zambian NGO), the Pediatric Prevention Research Center, Wayne State University, (Detroit, MI) and REPSSI.The outcome evaluation included a randomized control (waitlisted) trial of both primary school teachers and students.Outcomes from the trial indicate that intervention teachers reported positive change in relation to emotional self-care, use of teaching resources, classroom and school safety, school physical environment, social support, and gender equity for boys and girls.Intervention student data indicate positive changes for future orientation, school respect and support, school safety, school physical environment, response to sexual abuse, and bullying behaviors (Kaljee et al., 2016).

Primary Objectives
In addition to the outcomes evaluation (Section 1.4), qualitative data was collected to provide: 1) in-depth understanding of conditions and issues within the Zambian government school system from the perspectives of students and teachers; and, 2) process evaluation data to assess program challenges and successes throughout implementation.In this paper, we present these qualitative data from baseline and early implementation of the Teachers' Diploma Course.The primary objectives of this paper are to provide in-depth descriptive baseline data in relation to: 1) strengths and challenges for teachers and students within Zambian government schools; 2) school resources and learning environments; 3) relationships within the schools (teacher-administration, teacher-teacher, student-teacher, student-student); and, 4) relationships between teachers and parents/caregivers.In addition, we will present data on early experiences and indicators of change as teachers implemented the Teachers' Diploma Program within their schools.

Methodological Overview
Multiple qualitative methods were employed including: 1) focus group discussions with students and teachers in control and intervention schools; 2) structured observations at control and intervention schools; and, 3) informal observations and interviews with school administrators and teachers.Focus group discussions were utilized to obtain information on group norms and variation in these norms across populations (teachers and students) and research sites.The structured observations were used to obtain independent data on baseline social and physical environments in the schools and student-student and teacher-student relationships.The informal observations and interviews were a means of confirming information obtained during the focus group discussions and opportunity to ask emergent questions during the randomized controlled trial (Mack et al., 2005;Hancock et al., 2009).All qualitative data were collected by trained and experienced Zambian researchers between February and October 2013.

Research Sites
The Teachers' Diploma Program was implemented in six districts within three Zambian Provinces (Eastern Western, Lusaka).These sites were selected by the Zambian Ministry of Education, Science, Vocational Training and Early Education based on high HIV prevalence rates in these districts and resulting higher numbers of orphaned and vulnerable children.To ensure representation of the Teachers' Diploma implementation and evaluation sites (Johnson 1990;Guest, Bunce & Johnson 2006), data were collected from five primary schools, two secondary schools, and included both peri-urban (Lusaka Province, Kafue District) and rural communities (Eastern Province, Katete District).

Focus Group Discussions
Focus group discussions were conducted with teachers and students at the randomized controlled trial intervention and control primary schools and selected secondary schools within the implementation sites.Interview guides were developed and organized by topics (Hancock, et al 2009).Teacher guides included questions regarding: 1) rewards and challenges of teaching; 2) concerns about children in their schools; 3) experience and interactions with parents and guardians; 4) knowledge and experience about psychosocial support.For teachers on the program additional topics included: 1) experience with the Teachers' Diploma Program; 2) Teacher Diploma Program content applicability within their schools; and, 3) administrative and peer support and sharing knowledge from the program within their schools.For teachers not on the program, questions were included to understand their knowledge and perceptions of the Teachers' Diploma Program from what they had heard or experienced within their schools and/or school districts.Student guides included the following topics: 1) description of their school and teachers; 2) description of student-teacher interactions; 3) description of peer relationships and interactions.Additional topics that were probed included discrimination (e.g., gender), disciplinary actions, involvement of parents/caregivers in the school, school and class rules, and school safety.Focus group discussions were audio-taped, transcribed and translated into English by experienced Zambian research staff.A total of eight teacher (N=54) and eight student (N=38) focus group discussions were conducted.(Table 1)

Structured School Observations
Observations were conducted at intervention primary schools both with teachers in the Teachers' Diploma Program and teachers not on the course.A standardized observation form was used and divided by specific areas of interest.These included recorders' descriptions of: 1) educational activities; 2) teachers' behaviors and classroom interactions; 3) students' behaviors and classroom interactions; 4) teachers' behaviors outside of the classroom in relation to interactions with students; 5) students' behaviors and interactions with one another outside of the classroom; and, 6) the school physical environment (e.g., cleanliness, class sizes and crowding).A total of 30 school observations of 10 classrooms (~34 hours) were conducted between February and October 2013.(Table 1)

Informal Observations and Discussions
Time in the field during collection of both process and outcome evaluation data afforded trained research staff the opportunity to observe school and classroom activities, and interact with teachers and administrators.Some of these observations and conversations have been included as part of this manuscript as they constitute an additional source of support for the data collected through focus groups and structured observations.These data were not recorded, however staff recounted this information through field notes and conversations with research team members.

Data Management and Analysis
Utilizing a thematic approaching, the guiding framework for the analysis of the qualitative data was the primary tenets of the Teachers' Diploma Program.Additional emergent issues were also noted and documented during data analysis.The primary objective was to understand relationships between the texts of interviews within and between groups of respondents and 'thermal coherence' or how the texts express the respondents' recurrent assumptions, beliefs and goals (their "cognitive world").(Agar & Hobbs 1982) All data were read through prior to organization by topics.Topics included: 1) school infrastructure and environment; 2) teachers' roles and responsibilities; 3) within school relationships (administrators, teachers, students); 4) teacher-caregiver relations; and, 5) community-school relations.Key representative quotes from focus group discussions and notes from observations and informal discussions were highlighted and extracted to provide support for identified patterns and themes within each topic area.Data were reviewed and analyzed by two team members from the U.S. and Zambia and presented to other team members for comment.

Research Ethics
This study was approved by the Social Science Ethics Review Board at the University of Zambia and the Institutional Review Board at Wayne State University School of Medicine.Teachers provided written informed consent.Students provided verbal assent following parent/caregiver written informed consent.

Strengths and Challenges: Teachers and Students
Teachers and students outside of the classroom experience multiple challenges but also have strengths which can be fostered to contribute to their success as educators and learners.A global issue is low pay for educators.As one primary school teacher stated, "You find a teacher asking for the price of a tomato to be reduced just because the money is not adequate."In addition, many teachers describe social biases regarding the teaching profession which they feel is partially attributable to low wages.
"One day I asked the pupils in class how many wanted to be teachers.No one raised up their hands to say 'I will become a teacher'.Why?Because their interest is in these other jobs…like computer science, doctors, those good, good positions…."[Secondary school teacher] "The government policies have also contributed…the remuneration that teachers get has led others to look down on teachers…."[Primary school teacher] However, there were instances in which teachers describe communities as respectful of the teaching profession.A primary school teacher working in a rural area noted, "…the community gives respect.As a teacher, they want you, for example, if you go to their church to be a leader in that church because of that title of being a teacher." Teachers are well aware of the many challenges that face their students at home and in their communities.Such challenges include lack of food, need for children to care for themselves and other household members, access to school supplies, and long distances between home and school.One secondary teacher described the school's holistic role assisting students in need.
"When you look at these situations, everyone is concerned and must be involved.The class teacher, the subject teacher, matron and the school as a whole.The child needs empathy, sympathy, care and comfort…." Teachers described community and cultural gender-biases which affect a student's ability to attend and stay in school.Although a majority felt that girls were disadvantaged in terms of their ability to stay in school, boys were also described as leaving school for extended periods to work, e.g., herding cattle, and in some instances to participate in traditional ceremonies.A couple of teachers noted that they felt there were organizations to help girls stay in school but nothing comparable for boys.Alternatively, teachers also noted that boys have options to earn money and stay in school which are not readily available to girls.
"Some boys manage to do piece work to raise money to continue with their education.But for girls, they remain home to do chores or end up getting married at a tender age".[Primary School Teacher] One teacher described the role of teachers in fostering equitable treatment.
"What is important is to let the children understand from the start that they are equal and one in the class despite coming from different backgrounds.The teacher needs to understand this first as well and treat children equally in the class" [Secondary School Teacher] Teachers discussed difficulties identifying children with needs.As a secondary teacher stated, "It has been a challenge to identify vulnerable children as they do not want to be identified as poor…most students hide their vulnerability…." In addition, parents/caregivers may also be reluctant to accept assistance.

"Some parents or guardians don't feel comfortable if you help a child materially…." [Secondary School
Teacher]

School Resources and the Learning Environment
One of the primary challenges for administrators, teachers, and students is working within the systems-level infrastructure and resource-limited school environment.While teachers and students can potentially address some issues in the short term, other challenges require long-term commitment and structural changes to ensure a safe and supportive learning environment.
A primary concern expressed by teachers was the lack of space needed to maximize students' capacity to learn.In Zambia, many classrooms are severely overcrowded with limited table space, making it necessary for students to sit on the floor.Teachers describe classes with over 100 students.They also noted that such large classes decrease the amount of work given to students, thereby giving them less practice."…so instead of giving them an exercise of one to ten questions for them to practice, you will…give them two to three questions for you to be able to mark those books.So, they are not practicing so much…."[Primary School Teacher] Students also expressed concern about crowded classrooms.One secondary school student noted that crowded conditions made it "difficult to concentrate" and with classrooms always in use, "…there is no place for studying".Overcrowding issues were also noted during observations, where students were clearly having difficulty working within the limited classroom space and/or had no access to seating or desks.
In addition, as children and adolescents are in and out of school, there is often a wide age-range in a single classroom.In the randomized control study conducted as part of this project, within 3 rd and 4 th grade classes student ages ranged from 7 to 20 years.These age differences can also contribute to older youth dropping out of school when they are placed in the lower grades with young children.As one secondary teacher noted, "You find in the rural setting this time of year attendance in schools is very low as the homes don't have food…poverty affects attendance…as pupils are used in terms of field cultivation and others for cattle herding, you find in our situation a 17 year old in grade one and a 23 year old in grade nine…." In relation to the learning environment, both teacher and student focus group participants discussed roles and responsibilities of schools and teachers.For some teachers, the perception of their role is more in terms of 'controlling' the students.In many observations, teachers were seen distancing themselves from students during break periods and in some instances insulting students or make disparaging remarks about their work.Students highlighted that poor treatment by teachers affect their school work and self-esteem.
"When I was in grade eight, I never used to understand history.This is because the teacher was mean.He never used to say anything to anyone in the class or even greet the class when he came in…He even Observations in the classroom revealed a range of teaching methods and teacher interactions with their students.These observations included teachers 'who rarely spoke to students in the classroom unless they asked a question', and '[a teacher] who stuck to what he was supposed to teach but with no lighter moments for the children'.
Alternatively, multiple positive interactions and teaching methods were observed including hands-on activities, positive feedback on children's work, respectful treatment of students, and assisting children at different levels of ability.One secondary teacher was described by an observer as a 'facilitator' -as he introduced a topic, had students debate that topic on their own, and then came in to give more details and explanations.Other positive observations included teachers who knew their students and were able to call on them by name and greeted them when they entered the classroom.In focus group discussions, primary school children described positive experiences with teachers as those "teachers who joke with children" and "teachers who smile at children".
In Zambia as in many other LMIC education systems, the issue of corporal punishment is strongly divisive among teachers and is a prominent issue in discussions with students.During observations, a teacher was noted pinching the cheeks of a child for making noise.Another teacher was observed forcing a child to kneel in front of the classroom for an extended period of time.Among focus group discussions with students, teachers who were not favored were often described as "quick to punish" and as using beatings as punishment.

"When I was beaten by a teacher, I did not come back to school…I was comforted by friends…" [Secondary school student]
"Pupils were punished by kneeling in front of the class with [their] hands up for making noise in class.
And then one of them stood up and told the teacher he was tired.The teacher sent him away from class.We started getting frightened of that teacher".[Secondary school student] For some teachers, there is a perception that eliminating corporal punishment will decrease their effectiveness in the classroom.This issue is entwined in discussions related to children's rights, which takes on a negative connotation.Teachers express frustration regarding control within their classrooms and consequently their ability to educate students.
"The issue of human rights is also disturbing the whole system.When a pupil makes a mistake a teacher is limited in terms of punishment.What then is a teacher supposed to do in order to discipline a child?So, because we cannot do anything, we just tell them it is their future.For us, we have already made it, we are educated, it is up to them…."[Secondary school teacher] Through observations and discussions with students and teachers, information was obtained about students' relationships with one another and issues related to bullying and stigmatization.In a majority of observations, students were seen playing together in groups and interacting in a positive manner, e.g., sharing food.Students were also observed working together to keep the school grounds clean and cooperating on group lessons.
However, students were also observed engaging in verbal bullying and fighting in the classroom and the play area.A primary school child described "mean children, who call friends bad names and make fun of them".Another primary school student noted, "I like going to school…but I don't like fighting, insulting, stealing, and a dirty school…."Secondary students noted that students mock those who do not perform well in school or who are a part of a particular socio-economic group.
"There are rich and there are poor children.The rich have food at break and don't give to others; some girls can afford nice shoes and do make-up.Those who don't have these things, say bad things about them…."[Secondary school student]

Teacher-Caregiver Relationships
Teachers' experiences with parents and caregivers were often referenced during focus group discussion.These experiences and perceptions varied considerably.Teacher's concerns centered on parents/caregivers who were disrespectful or apathetic toward education.
"The major concern is absenteeism.Many pupils absent themselves.So many parents are concerned with wealth…even if you report [absenteeism] to the parent, they don't care…."[Secondary school teacher] "…in villages like here some parents are not well educated, some of them stopped school in grade one or grade two, so as a result they don't know the importance of education, so they don't reinforce it to their young ones…it becomes a challenge, it is a tug of war between a parent and a teacher for the child to be in school…" [Primary school teacher] Teachers recognize that it is "important to be close to caregivers" and provided accounts of working with parents or caregivers which resulted in positive outcomes.
"When I was working in [name of area], a parent approached me over a child's poor results.We had a good chat and I explained to him why the child was failing.Then he asked me how he could be of help.I advised him.From then, the child changed his behavior and his results started to improve…."[Secondary school teacher].

Implementing the Teachers' Diploma Program: Early Challenges and Successes
Participants in the Teachers' Diploma Program discussed their experiences and how the program was being implemented within their schools.These discussions included mention of self-care, improving the school environment, enhancing relationships, and providing psychosocial care to children.

"[the whole school] has to create first of all a conducive environment for the learner. Then apart from that, we have to sensitize the community on the importance of a child coming to school…." [Teacher at residential training] "We have the action plan, we have begun to talk about children's rights, started improving the physical surroundings of the school, [and] also offering emotional support….." [Teacher at a Community of Practice session]
Participating teachers stated that they receive administrative support for time spent in the Teachers' Diploma Program and have opportunity to discuss the program with caregivers at the school parent-teacher association.However, they also expressed that some of their peers did not initially understand the program and were thereby less supportive.This was reflected in some comments from non-participating teachers.
"Why should it be that everyone has to be involved when someone else is doing the diploma?We feel like we are doing work on behalf of someone else…."[Primary school teacher] Other non-participating teachers had positive comments about the program noting that "the school surrounding area has already started changing" and "[participating teachers] have started sourcing for funds from NGOs…."One primary school teacher who was initially skeptical of the program described these early changes.
"…I can tell you that this program is very helpful and working.The teachers on the program are very helpful for counseling the students…we have a good environment for ourselves and the students.You can see by how the outside is looking.The students are contributing their ideas on how they want the school to look.Many teachers are involved in responsibilities and community members are coming to cook for the school feeding program…." Concerns expressed during early implementation by participating teachers included issues related to recognition of the Teachers' Diploma Program and impact on their position and salary and concerns about time commitment.A few program participants also expressed some skepticism of the program's usefulness.
"We need to be motivated if we are doing this diploma.[But] if it is not recognized it will not help us…will our salary scales change?"[Teacher at a Community of Practice session] "…if you are teaching double classes, after that you go and look at the module when the brain is tired…" [Teacher at a Community of Practice session] "Some participants have received the program with both hands.For some they think it is another waste of resources.Others are not happy about not beating the child, saying 'how will we manage these children?'….

" [Teacher at a Community of Practice session]
During structured observations after the Teachers' Diploma Program had started, program staff noted positive changes in the intervention schools' social and physical environments.Outside at one school, the grass was hedged by newly painted decorated stones.Students were more freely participating in class and teachers appeared to be more encouraging of students.In another school, teachers were becoming more involved in extracurricular activities, e.g., drama, music, sports clubs.In contrast, little or no change was seen in control schools and many were described by observers as untidy and noisy.Several months after the Teachers' Diploma Program started, research staff commented that they could tell whether they were arriving at an intervention compared to a control school based on immediate observations of students in their classrooms working in groups and the school looking like they were places of 'learning'.
In an informal exchange between project staff and a teacher not on the program but in an intervention school, the teacher expressed skepticism about the program.He was suspicious of REPSSI's 'human rights' agenda and the program's emphasis on discouraging corporal punishment.
'Why should we assist our friends in their studies by participating in this program here at school?How will the learners be disciplined if they are not punished?We do not need these human rights you are bringing to our schools in the name of psychosocial support.'However, when our team visited the school a few months later, the teacher welcomed the project staff and claimed the program was hugely beneficial.
'I really appreciate this program a lot.These teachers on the program are able to handle these learners better than I have been able to.Also just look at the school grounds and the classrooms, it is all because of these teachers.This program is really good.I would also want to be part of this course.So how can I join?'

Discussion
The Teachers' Diploma Program was developed on a framework which emphasizes the needs of teachers and their students, creation of a positive social and physical environment for learning, and development of strong interschool and school-community relationships.Through these qualitative data, we have obtained an in-depth description of conditions within the schools from the perspective of teachers and students.These data both illustrate challenges to be addressed and strengths to be enhanced to create child-centered learning environments in Zambia.
These data provide a clear overview of the difficulties which Zambian teachers face on a day-to-day basis.Such challenges include large numbers of students in a single classroom, a wide age-range of students, and little to no resources.These teachers also work with many orphaned and vulnerable children (OVC) who are living in poverty and come to school tired and hungry.These children often attend school on an irregular basis or drop out because of lack of money or the need to work and help provide for their families.In our baseline qualitative data, teachers recognize their role in helping students through identifying their needs and finding resources.However, in many instances children do not want to be identified as 'in need' and/or teachers are overwhelmed with day-to-day tasks.
Interviews with students and school observations highlight the range of teachers' approaches to education, and the positive outcomes associated with strong teacher-student relationships, interactive teaching, and a supportive classroom environment.These data also highlight the negative consequences of corporal punishment, harsh criticism, and poor communication on the part of teachers.
The data suggest that the Teachers' Diploma Program is based on the realities of the teachers' experiences and work environment.The data also support the underlying premises of the course.Moreover, the qualitative data support findings from the randomized control trial (RCT) that the program brings about changes in teachers' self-esteem, relationships, and the school environment.Teachers in the program discuss increased confidence in their abilities to make changes and their role as change agents.Program participants are taught new approaches and skills which can be quickly put into practice.These changes include implementing class management approaches as opposed to corporal punishment, enhancing teacher-student and teacher-caregiver relationships, and improving the physical appearance of classrooms and schools.
These data also show that not all changes can happen in a short period of time, and some teachers and administrators may need more time and evidence to fully embrace changes.As with the RCT data, concrete changes such as planting flowers, increasing extracurricular activities, and modifying teaching approaches are first steps to establishment of a school environment which provides needed psychosocial support and resources for both teachers and students, an integrated school and community to support children and their families and ultimately increase school attendance and retention.
Evaluation of the Teachers' Diploma Program has offered a unique opportunity to assess a school-based approach to improving the psychosocial well-being of OVC in Zambia.Scientific evidence has previously suggested children and adolescents can be resilient and that psychosocial support programs can enhance resiliency and reduce likelihood of poor emotional, psychological and physical outcomes.In addition, national level mechanisms are needed to improve and support scale-up of effective policies and programs for OVC.(Hong et al., 2010;Smith et al., 2012;Nyberg et al., 2012) At this time, the research team is completing complementary quantitative analysis of baseline data from the randomized controlled trial to further support these qualitative findings.Additional qualitative data was collected in 2015-2016 with a focus on program impact including how the Teachers' Diploma Program was implemented within the schools, facilitators and challenges in implementation, and program sustainability.These data are being analyzed and published.
As the Zambian government implements the Teachers' Diploma Program within the teachers' colleges, the outcomes and process data from the four-year evaluation will be used to further improve the course to meet the needs of teachers and students and guide the implementation process within different socio-economic contexts in Zambia and the region.

Limitations
While the qualitative data provides important in-depth information, there are limitations in terms of its generalizability due to a relatively limited number of research sites and respondents compared to what is typically found in quantitative surveys.However, as previously noted, these qualitative data are supported by the quantitative randomized controlled trial baseline and longitudinal data analysis.As the program is institutionalized throughout the country, implementation research will be an important component to assess program delivery processes on a larger scale and program effectiveness within a broader range of contexts.

Conclusions
Throughout East and Southern Africa, there remain multiple barriers and challenges which affect children's school attendance and performance.The Teachers' Diploma Program in Psychosocial Care, Support, and Protection is child centered and focuses on providing teachers with the knowledge and skills necessary to enhance the school environment, provide psychosocial support to their students, and facilitate strong school-community relationships.These process evaluation data support the underlying premises of the Teachers' Diploma Program and the relevancy of program content for teachers' daily experiences.Furthermore, these data show program changes that teachers are making in their classrooms and schools.These qualitative data in combination with the randomized controlled trial data (Kaljee et al., 2016) support the need for school-based psychosocial support systems as a part of broader community-based interventions to facilitate teachers' abilities to support students and their families and increase child resiliency.
provided by the International Special Initiative Grant, Comic Relief, UK (GR002-12532; Mainstreaming psychosocial support into the education system to enhance education outcomes)

Figure 1 .
Figure 1.Framework for the teachers' diploma course

"
It is very difficult to monitor say 40 or 50 children in one class.You cannot give them individual attention hence it is difficult to monitor their performance.So, what we do is get the average performance.If most of the students seem to understand, we move on…."[Primary School Teacher]

Table 1 .
Overview of qualitative data collection Teachers described themselves as communicators, learners, and listeners.As one primary school teacher noted, "all teachers are counsellors and do what they can to help.""…Standing there in front of the children is interesting because you will find that you meet different pupils coming from different homes giving you views of what they do in the villages.You communicate with them through the teaching…and… you learn to interact with the community through teaching…."[PrimarySchoolTeacher]"…I have been able to mostly interact with people, pupils especially.The way they open up to me, the way they open up to teachers.I came to realize they trust teachers a lot…what we say as teachers truly motivates them…."[SecondarySchool Teacher] "Children's basic needs are not met and they also lag behind as a result of not having textbooks".[Primaryschoolteacher]"[children travel] long distances from home…children get to school already tired and cannot concentrate".[Primaryschoolteacher]"I think the biggest problem is poverty… these children come with only empty stomachs….[Primaryschool teacher] wrote on a dirty board, so it was difficult to learn or understand what he taught…."[SecondarySchoolStudent]"Iwas going through a math paper and one question was hard.I went to the department to ask for help.I found a certain teacher who instead of helping me, teased and told me to wait until that topic was taught in class.I was disappointed that he discouraged me…." [Secondary school student] Teachers expressed the satisfaction that they feel when students learn and excel.Understanding relationships within the schools requires awareness of biases and inequities that exist based on gender, ethnicity, and/or socio-economic status.One secondary school teacher noted that "…you as a teacher, you make them understand since they are in the same grade, no one should be above the other...you are at the same level…."While observations revealed little indication of inequitable treatment of students, focus group discussions revealed underlying gender-based biases among some teachers.
"I have taught at a boys' and a girls' school and the difference I have noticed is that boys are more active than girls.Boys easily follow instructions as given to them and within a specific time, unlike girls.For girls, you have to push them around if you want work done…the other thing is that girls don't like mathematics, so if you are not careful with them…their mathematics attitude…the children may be failing…."[Secondaryschool teacher]