UYAHF in partnership with Naguru Youth Health Network (NYHN) and the AFRIYAN; which is a network of youth-led and youth-serving organizations in Uganda, conducted a youth-led rapid assessment on access, uptake, availability, and quality of youth-friendly services in 2 GFF districts. The rapid assessment also sought to understand the scope of youth-friendly services, policy provisions, and commitments in the RMNCAH investment case, challenges, and experiences of young people in accessing youth-friendly services, and the extent to which these services fit the Universal Health Coverage framework.

On Wednesday 2nd Dec 2020, UYAHF and NYHN organized a half-day meeting to launch and disseminate the findings from the rapid assessment of young people’s experiences, challenges, and best practices on demand, access, and utilization of youth-friendly services and information, a case study of Busia and Pallisa district and the youth advocacy coordination and action plan on RMNCAH and GFF in Uganda at Fairway hotel. The launch was comprised of 26 physical participants (F=10, M=16) and 24 online participants from CSOs, academia, government institutions, World Bank, World Health Organization among others.

Ms. Winnie Apio in her opening remarks gave a quick update about the project and stated that they were able to carry out the evidence-based research in Pallisa and Busia districts which they found imperative to share with a wider audience for increased advocacy efforts as regards SRHRs for the young people. The project is for one year that would have ended earlier but due to the pandemic some of the processes slowed down. Several activities have been carried out such as consultative meetings with key stakeholders, validation meetings for the assessment and development of the advocacy plan, launch of the youth action plan, and the development of the youth action plan.

Dr. Grace Murindwa from World Bank gave opening remarks whereby she appreciated UYAHF and NYHN for a great job well done and also talked about some of the effects of the pandemic such as; high post-abortion rates in the country and high mortality rate, high levels of teenage pregnancies among others. The forum should address and support adolescent youths by drafting the new action plan for family Planning and ensure that adolescent health is addressed. Adolescent health isn’t allocated money there is a need to advocate for a specific budget to address youth health issues.

Ms. Apio Winnie Programme Manager UYAHF presented a brief about the project and overview of GFF processes at the national and global level, where she stated that the project was a result of key meetings between UYAHF and NYHN in 2019 that aimed at achieving the following objectives:

• By 2021, support youth-led organizations in Uganda, to develop an evidYouthence-based joint youth advocacy action and coordination plan to enhance meaningful youth participation, transparency, and accountability for GFF and the RMNCAH investment case for Uganda.

• Work with the consultants to see how youth adolescents can be involved and the issues of maternal health

• Rapid assessment on access uptake, availability, and quality of youth-friendly services and linkages to UHC

• Principals and frameworks in two RBF districts (Pallisa and Busia)

The expected outcome was coming up with the document that allows link minded partners to come together to improve maternal health for young people. While relating to the opening remarks by Dr. Grace, Winnie confirmed the willingness of UYAHF to work with The World Bank to move the advocacy agendas using evidence generated from the grassroots communities as well as emphasizing the need for the youth-led organizations to be more organized as they move their efforts.

Patrick Mwesigye, team leader UYAHF appreciated everybody for being part of this launch and called upon the participants to utilize the advocacy action plan so that we implement using evidence from the grass-root communities. He went on and stated that there should be the empowerment of young people and dissemination of policies that should guide young people while planning and implementation activities. There is a need to be more specific consultation for the young people at all levels, support young people to advocate for their rights by knowing their priorities and integrate them accordingly.

Miss Winnie Apio sharing the report findings with participants

A young mother from Busia, Lorrine Ayango shared some of the challenges faced by teenage mothers while trying to get SRHR services at a health center during a lockdown:

• The young mother, recalls that before the lockdown was announced, the young people were not prepared for what was coming, and therefore during the pandemic, access to SRHR services was a major challenge.

• Health services were also expensive since people were not working.

• There was also a challenge of denied maternal health due to lack of privacy since they are served in the same rooms with adults.

• Couldn’t access immunization services for their children due to transport challenges.

• Long distances to access post-natal services midst the ID strict requirement.

• Poor feeding leading to undernourishment of their babies.

• Lack of information about SRHRs which made her get pregnant at an early age.

• Laurine furthermore argued that children should be involved in decision making as well as bridging the gap between young people and the decision or policymakers.

On what could have been done differently to prevent teenage girls from getting pregnant:
• Lorrine emphasized that information about SRHR is very key and if she had information as regards family planning at an early age, then she wouldn’t have gotten pregnant at an early age. The lack of SRHR information is the main reason for the skyrocketing teenage pregnancies in the country.

• Creating awareness among young people.

• More information on livelihood is needed so that young people have a start-up business and look after themselves without relying on men for support.

• Social accountability, everyone should play their part to ensure that young people have correct and accurate information to enable them to make informed decisions.

• Making the victims the ambassadors of change as they have lived the experience.

Laurine sharing her experience as a young mother

Ms. Apio Winnie took the participants through the background, purpose, objectives, gaps identified as well as putting more emphasis on recommendations.
The research was undertaken using a mixed research method to collect both qualitative and quantitative data. The study areas were Pallisa and Busia districts which were categorized by the investment case for RMNCAH. This was however a case study that was undertaken using mixed research methods to collect both qualitative and quantitative data.

The project has four core components i.e. (i) Results-Based Financing (RBF) for Primary Health Care Services targeting specific RMNCAH services with low coverage, (ii) Strengthen Health Systems to Deliver RMNCAH Services, (iii) Strengthen Capacity to Scale-up Delivery of Births and Death Registration Services, (iv) Enhance Institutional Capacity to Manage Project Supported Activities to achieve the following targeted Project Development Objectives (PDOs) of; improve utilization of essential health services with a focus on reproductive, maternal, newborn, child and adolescent health services in target districts and scale-up birth and death registration services.

Although the RMNCAH sharpened plan investment case articulates the key strategies for improving adolescent health, the URMCHIP that operationalizes the RMNCAH sharpened plan conspicuously omits a component of adolescent health in its title and largely prioritizes maternal, newborn, and child health-related services. Across the districts reached for this assessment, there is an evident lack of deliberate planning targets for adolescent health specifically compared to other RMNCAH related indicators. Key findings:

• The lack of adolescent health-related platforms at local government levels compared to the national level makes adolescents health a least considered priority in most local governments.

• A review of the URMCHIP implementation manual reveals that though Post Abortion Care services are elaborated in the project appraisal document as one of the key services to be incentivized, the current outputs being incentivized omits post-abortion care services. The focus on EmOC under RBF/GFF is specifically on childbirth complications.

• Busia is just at the initial stage of initiation into RBF while Pallisa is among the initial pilot districts but already there is high exuberance among the health workforce. Analysis of the guidelines for RBF implementation shows a low scope of and focus on adolescent health services with an exception of MNCH.

• The RBF will/has provided (d) an additional basket of funds to the health system. It is likely to raise health facility resources.

Challenges faced by young people;

• Stock-out of medicines increases their vulnerability especially those from poor households who are referred to clinics/drug shops to buy the prescribed medicines.

• Lack of youth/adolescent-friendly corners at the facilities at all the facilities assessed health facilities coupled with low responsive adolescent health service delivery approach.

• Long waiting time/delay to get services at health facilities partly due to a few health workers.

• Limited laboratory services especially to test and determine suitable family planning methods for them.

• Stock-out of medicines increases their vulnerability especially those from poor households who are referred to clinics/drug shops to buy the prescribed medicines.

• Lack of youth/adolescent-friendly corners at the facilities at all the facilities assessed health facilities coupled with low responsive adolescent health service delivery approach.

Recommendations

• Adoption of specific indicators on adolescent’s health in the next round of RBF.

• Harmonization and adoption of some planning indicators for adolescent’s health in district plans.

• Creation of a specific budget for adolescent’s health in districts to operationalize adolescent’s health plans and strategies.

Dr. Jesca Nsungwa from the Ministry of Health in her closing remarks appreciates the report since the research was done by young people themselves and brought out youth issues. Disseminating this report comes in at the right time as they are working on the second sharpened plan which can be an opportunity to include youth issues. The Covid 19 pandemic has exposed a lot of youth vulnerability and there is a need to reprogram accordingly. There is a need to segregate the 11 indicators and pick on those that suit the young people since bringing new indicators on board may be hard and tricky. She also briefed the audience about the 5 domains that the government is working on and these are promoting wellbeing, connectedness with young people, a supportive environment, learning, and meaningful participation.
She made her major asks to the audience some of which included, not leaving these conversations in Kampala but be moved down to the grassroots communities, continuously work with young people, and the need to centralize programs consider programs that look at vulnerable groups of young people, utilize the existing structures like the use of VHTs and ‘bizidalo’ and change measurements /indicators other than looking at outcomes. The meeting was concluded by Dr. Jessica launching the report and advocacy plan and encouraged us to share the findings with the Ministry and other health partners for their engagement and support.

Dr. Jessica giving closing remarks

Media links

Youth left behind in health care provision — UYAHF report