 |
           |
Information Resources"Health
Matters" | Facts
and Figures | Reports
and Articles | Research on Adolescent
Sexual and SECTION III STAKEHOLDERS AND INTERVENTIONS ON ADOLESCENT SRH IN UGANDA A number of stakeholders that include government, international donor agencies, local NGOs and CBOs have come up to work towards the plight of adolescent SRH. Currently interventions include policy developments, behavioral change activities, services delivery and attempts to build ARH program management capacity. 3.1 Policy Development and Implementation The government has enacted policies to reinforce young people’s health and development:
Ministry of Health has developed a draft adolescent health policy whose objectives are to mainstream adolescent health concerns in the national development process in order to improve the quality of their lives, participation in matters of development and raise the standard of living of young people (MOH, 2000). The policy addresses adolescent problems and needs in a multifaceted way. The Policy is an integral part of the national development process and reinforces the commitment of government to integrate young people in the development process. It recognises the critical role that adolescents themselves can play in promoting and emphasising the need for their participation in planning, implementation, and monitoring and evaluation programs. It also seeks to strengthen and to provide enabling social and legal environment for the provision of high quality, accessible adolescent health interventions. Realising that adolescents do not have easy access to RH services partly due to lack of accurate information on the available services; and the need to access them, as well as absence of adolescent friendly services, the government of Uganda and UNFPA made a number of recommendations relating to adolescent reproductive health (The Country Population Assessment report, GOU/UNFPA, 1999)
3.1.1 MOH Initiatives at District Level One of the roles of the Ministry of Health is to strengthen the capacity of District Health Management Team to develop district plans. To this effect a Planning guide for reproductive health program has been formulated to assist various planners and implementers at national and district levels to identify and prioritise community and reproductive health service needs (MOH, 1999). Districts are to plan, implement, and monitor selected interventions to address the identified RH needs in the planing period. The districts have to mobilise and allocate appropriate resources to those cost-effective interventions geared at reduction of maternal and perinatal mortality and morbidity and promotion of adolescent and family health. MOH has also developed the SRH Minimum package for Uganda. Adolescent Sexual and Reproductive Health is one of the five key components. 3.1.2 MOH proposed Priority Areas (MoH, 1999) The Ministry of Health in its effort to strengthen Sexual and Reproductive Health for Adolescents in the country has proposed priority areas that include:
3.2 Behavioural Change and Services Delivery Interventions Various organizations have come up to intervene through behavioral change and service delivery strategies for adolescents. Below an analysis is made of the specific approaches they are using, activities they are engaged in, the constraints, lessons learnt and future plans. UNICEF One of the programs dealing with adolescents in UNICEF is the Basic Education, ChildCare and Adolescent Development (BECCAD). It was conceived to deal with the psychosocial and cognitive needs of the Ugandan child in a holistic manner. Its sub-programs focus on promoting basic education, through, strategies that are complementary to UPE and are directed at the most vulnerable children and girls, improving childcare protection and fostering adolescent development. On adolescent development major achievements included the development of a new approach to life skills education, both in and out of school, with the integration SARA Communication Initiative (SCI) and adolescent friendly services. BECCAD has provided support to eight NGOs in the implementation of peer education/ lifeskills education on sexual and reproductive health. It has revised the program for in school psychosocial life skills education. Past efforts beginning in 1995 focused on developing wide scale ownership through a multi-subject, relatively slow, infusion approach, which never reached the classroom. The new strategy developed in collaboration with the National Curriculum Development Center (NCDC) and Institute of Teacher Education Kyambogo places life skills in the health science category on school curricula. BECCAD has also supported various communication initiatives including Straight Talk, Young Talk; a radio program linked to the Naguru Teenage Center for AFHS in Kampala; the Philly Lutaya Initiatives outreach program of AIC which involves people with AIDS as the main communicator (UNICEF Country Program Report, 1999). Adolescents in 29 districts are being reached through UNICEF supported Basic Education for ChildCare and Adolescent Development (BECCAD). This program has developed resource materials to train service providers, teachers and community resource persons to develop relevant life skills of adolescents DISH/PRIME/INTRAH Project The project of improving adolescent use of reproductive health services in public health care facilities was conceived by MoH and PRIME/INTRAH after a realization that adolescents did not seek care in health facilities though they suffered from a number of reproductive health problems. As part of interventions, MoH) and the District Health Management Team (DHMT) in Jinja district, in collaboration with PRIME/INTRAH, established an adolescent friendly reproductive health ARH pilot project within 4 health facilities in Jinja district. The objectives of the ARH project were to:
The strategy adopted while implementing the ARH pilot project included:
In order to determine the impact of the intervention with Adolescent Friendly Reproductive Health (ARH) project on facility/Services utilization by adolescents, an evaluation was conducted after one year of ARH project implementation. It revealed an increased utilization of health services by adolescents for all the range of services provided at the pilot health facilities.
Constraints/lessons Learnt
Future Plans The project intends to expand at health center level III and expand to 12 DISH districts with different models specific to the districts. UNFPA The first UNFPA country programme started in 1985-1987. During this period the programme was aimed at strengthening population and family life education, improvement of MOH family planning services and enhancement of status and role of women and youth. The third programme had a component for the initiation of a program to improve adolescent sexual and reproductive health. UNFPA fourth country program that started in 1997 has three subprograms: Reproductive health; Population Development strategies and Advocacy. Each subprogram consists of several component projects. Those projects specifically related to adolescent RH is: Program for Enhancing Adolescent Reproductive Life (PEARL), and the NGO Track. PEARL Project PEARL Project aims at improving quality of life among adolescents. It targets mainly out of school adolescent boys and girls aged 10-24 years. It also targets community leaders, parents, religious leaders, youths and adolescent organizations. The project was to develop community centers as focal points where adolescents could meet to receive RH messages and services and get involved in other socio-economic activities that could uplift their lives. The project has the following specific objectives;
Achievement of the PEARL program A recent evaluation of the PEARL Project (Ntozi et al 2000) reported that since it was established in 1997, the PEARL program has been firmly established in 8 districts. In June 1999, five more districts were added to the program and the process of implementing the program in these districts is on going. Renovations of community centers have been completed in the first 8 districts. The community centers are being used by adolescents for meetings, drama, seminars and other non RH activities. The main RH activity that takes place at the community centers is RH counseling and guidance. Peer mobilisers were recruited and materials provided to facilitate them in their work Constraints for the PEARL program Poor data collection at the district facilities affects the planning process for adolescents Sustainability of the PEARL program is subject to doubt since the PEARL program depends on UNFPA as its most important source of financing. Although districts have a vote for youth programs under which PEARL falls, money on these votes were reported to be very small if provided at all. Some peer mobilizers have dropped out due to lack of motivation, migration and out growing adolescence. There has been inadequate IEC materials and were limited in their coverage of ARH issues and sometimes needed to be translated in local languages Lessons learnt Parents and the community are supportive of the adolescent program. They encourage the PEARL structure to continue and expand in order to reach more adolescents. The survival skills and other artisan training planned in the program have not taken off. It is thought that if in place, these activities will attract more adolescents in the community centers. Adolescents with good educational background if given training and relevant reference materials can be effective in reaching fellow adolescents with RH messages. Recommendation Some of the suggestions from the review were: Closer supervision and frequent visits from senior staff at headquarters should be encouraged since this can boost peer mobilizer's morale; Artisan skills and vocational training which was one of the objectives of PEARL should be started and peer mobilizers should take the lead; Encourage visiting programs with a view of making it possible for peer groups from one part of the country to travel and learn from others in another part of the country; Strengthen monitoring and supervision of PEARL activities at parish and sub-county levels. Create a robust data base at the district and national levels that can be used for effective monitoring and supervision of the program. The NGO Track Through NGO track UNFPA has supported NGOs in various reproductive health projects. The purpose of the NGO track is to contribute to the overall goal and purpose of the RH sub program is to increase awareness, motivation and adoption of safe reproductive health behaviour and practice; and increase accessibility and utilization of reproductive health services. About Eleven NGOs have received support from UNFPA under the NGO Track. Eight of these are dealing in Adolescent Sexual and Reproductive they include: Family Planning Association of Uganda (FPAU) – (Increasing access to sexual and RH service including FP) Naguru Teenage Information and Health Center, (Enhancing Adolescent RH) Religious Institutions – Diocese Kampala Diocese, "Adolescent RH". Cultural Institutions/Kingdoms Among the strategies of reaching adolescents being used by some of these NGOs under the Track are to sensitize parents, schoolteachers and youth counselors about on issues affecting the lives of adolescents. Services provided by these organizations include counseling and guidance, training of service providers, advocacy activities to mobilize support for RH, RH/IEC and RH service delivery including; FP, STD treatment, ANC, Delivery Care, HIV counseling and testing. A youth clinic at Kisenyi, supported by the Buganda Kingdom has treated a total of 166 adolescents for STDs in the first quarter of this year (January to March). Namuwongo Adolescent Center, ran by Kampala diocese 559 adolescents have received counseling or treatment services since the year begun. Of these 75 (13.4%) received treatment for STDs, 54 (9.7%) were counseled for family planning and 28 (5%) accepted family planning (Ntozi et al 2000). Constraints of the NGO Track Lack of adequate funding leading to planned activities not being effected; issues of sustainability of some projects, lack of needs assessment for the various NGOs of the Track. Lessons learnt The evaluation of these projects (Ntozi et al, 2000) revealed that NGOs, religious and cultural institutions are willing to collaborate with government, international agencies and other stake holders in promoting RH especially in areas where they have comparative advantage. The NGO track has enabled NGOs to share experiences and resources such as technical support and IEC materials. Reproductive, Educative and Community Health (REACH) The program aims at enhancing the RH conditions of all the people in Kapchorwa (especially the prevention of HIV and the reduction of maternal mortality) and discard the harmful practice of female genital cutting (FGC) while promoting cultural values among the community. The practice causes severe pain, may result in excessive bleeding and increases the risk of infection including HIV/AIDS. Other consequences are painful intercourse and difficulties during childbirth. It is also said that FGM leads to slow sexual desire. In the REACH project, an integrated community based, culture sensitive and persuasive approach is used to encourage the community to discard the practice of FGM. This approach aims at separating the actual practice of cutting (which is harmful and should be discarded) from the cultural values of the initiation into adulthood. The strategies include sensitization of community members through workshops, seminars, peer education and study tours, in order to increase the communities' awareness of RH issues including the consequences of FGM. The target groups include community, religions, cultural and civic leaders, parents and parent-in-laws, men, women and youths, uncircumcised young couples, and FGM "Surgeons". In addition, training and equipping of TBAs, and construction of health units in the district was done to integrate the campaign against FGM and the promotion of reproductive health generally, by increasing accessibility of RH services. Achievements The project has gained the support of politicians both at national and community levels. The prevalence of FGM among the Sabiny girls has declined. Studies show that the FGM incidence among the Sabiny began declining in 1992. However, the biggest drop rate (60%) was recorded between 1994 - 1999 (Kiirya and Kibombo 1999). This decline in attributed to increased sensitization and mobilization of community members against the practice by REACH, EPAU, Born-again churches, and human right activists, politicians and community leaders. Community attitudes towards eliminating the practice of FGM are improving in that there is a growing negative attitude towards FGM. Studies show that 82% of the unmarried males are not in favor of marrying circumcised women. Likewise, 85% of the females eligible for circumcision object to undergoing FGM. A large proportion of the Sabiny (76%) would neither accept to present their daughters or recommend any other woman/girl to undergo circumcision. Despondency towards FGM is also growing among the Sabiny, 68% favor FGM eradication while 11% want it modified. Only 21% want FGM to be maintained. Constraints Despite the gains as stated above, total elimination of FGC is still difficult because of the following reasons: The community attaches a lot of benefits from FGC. The trade provides income for the local surgeons, their aides, high dowry for parents, gifts for candidates and parents, and festivities such as eating, drinking and dancing. Practicing FGC is a means for preserving girl’s virginity and regulating sexual desire and promiscuity. Restricting uncircumcised women/girls to perform certain functions such as milking cows, collecting food from the granary, stepping in the Kraal, serving brew or food to important people is institutionalizing FGC. Low levels of girls/women education and lack of economic empowerment for the girls/women to be able to make independent decisions and reach avenues through which norms associated with FGM are reproduced. Lessons Learnt Cultural transformation of eradicating FGM is attainable if socio-economic and cultural alternatives are created that ensure maintenance of what community members benefit from FGC as the practice is eliminated. AMREF AMREF has been implementing behavioral change efforts in six districts. Currently it is implementing the Youth Sexual and Reproductive Health Project (YSRH) in Rukungiri South Western Uganda. The overall goal of the YSRH project is to improve and sustain the health status of adolescents in Rukungiri district with an emphasis on prevention of STDs/HIV/AIDS and unwanted pregnancy. It aims at empowering the young people in 50% of the schools with knowledge and information about their sexual and reproductive health, responsible parenthood, provision of education materials, training of teachers, student peer educators, and orientation of parents regarding HIV/STD prevention and awareness. The project targets 120 primary and 30 secondary schools and two Teacher Training Colleges. The activities are carried out in collaboration with the district education and medical offices. The project was initiated as a result of experiences in school health programmes in Kabale, Soroti, Luwero. Rukungiri was used as a control in the evaluation of ASRH activities and the results indicated a need for intervention in the area. Achievements Informal health providers (46) were trained in
youth friendly approaches More youth are readily seeking counseling services from school health officers on sexual problems and in health units. The youth are seeking more information on safer sex methods Reduction in pregnancy and defilement cases in schools Lessons Learnt Success of school based health programs depends on the commitment of the program by the school head teachers
Straight Talk Foundation (STF) Straight Talk Foundation (STF) was registered as an NGO in March 1997. Its broad objective is to contribute to the improved mental social and physical development of Uganda Adolescents (10-19 years) and young adults (20-24 years). Its overall programme aims at keeping its target audience safe from HIV/STD infection and early pregnancy. More specifically, STF aims to increase the understanding of adolescence, sexuality and reproductive health and to promote the adoption of safer sex practices. STF activities support adolescents to successfully develop into adults. This includes giving adolescents accurate information about their health and bodies, child/human rights, HIV and other sexually transmitted infections. STF supports provision of information for young people to develop life skills such as assertiveness, confidence building and decision making. The project goal, purpose and outputs are: Goal: Adolescent mental, physical and social development in Uganda improved Purpose: Children and youth empowered to make the passage through adolescence safely. Output:
Lessons: Most of Straight Talk Foundation problems are growth related being a new NGO. However it is ware of the risk of taking on too many projects prematurely before development of the administrative and other technical skills through on job training and short courses for key staff. Delayed funding has at time constrained STF activities The out of school, illiterate, and the very rural adolescents have been difficult to reach by STF. Some of these adolescent live in an information vacuum and are very disadvantaged. It is hoped that in future STF will be community or school owned for sustainability purposes. Naguru Teenage Information and Health Centre (NTIHC) Naguru Teenage Information and Health Centre is a youth clinic that offers adolescent friendly services that include RH services. The activities and services include:
Achievements Attendance to project activities by adolescents has steadily increased over the last four years. With the provision of quality adolescent sexual and reproductive health services there has been an increased accessibility and utilization of these services including adoption of safer reproductive health behaviour and practices. During a period of two years it was expected that there would be 8,800 attendencies and 8,000 condoms distributed to this service. However in 1999 and 2000 the clinic registered over 26,000 attendencies and about 69,000 condoms were distributed. Lessons and recommendations STD treatment is still the main medical problem dealt with at the project Difficulties in reaching younger adolescents: programs need to prepare them for the future though they seem not to have as many sexual and reproductive health programs. The Project needs to explore ways of increasing resources given the increasing clientele over the years, but also maximize its efforts through IEC activities. Prevention efforts should also target the younger adolescents through the parents on the Speak out Teen show. The project should increase accessibility to services by opening on Saturday but also as late as 6.00 p.m. Strengthening collaboration with referral places by follow-up and meetings African Youth Alliance (AYA) The African Youth Alliance Initiative is a United Nations Population Fund (UNFPA) Program for Appropriate Technology in Health (PATH) and Pathfinder International Joint Initiative. It is a program funded by Bill and Mellinda Gates Foundation. This program will be executed by the three alliance partners; UNFPA, PATH and Pathfinder working closely with the Government of Uganda through the Ministry of Gender, Labour, and Social Development and with selected, national and local NGOs and community action groups. The overall goals of this program is to contribute to the reduction of adolescent reproductive health problems including the incidence of HIV/AIDS, STDs and unwanted pregnancy in Uganda by the year 2005, through a multisectoral, scaling up, nation-wide approach. The purpose is to contribute to increased access and utilization of reproductive health by adolescents, and increase adoption of positive sexual behaviour. Overall Strategy: To reduce significantly unwanted pregnancies and the high rate of STIs and HIV/AIDS among young people. Aims at providing a constellation of services and information designed specifically to meet the reproductive and sexual health needs and concerns of young people and adolescents. Program coverage: To cover the entire country, to elaborate and build on existing activities supported by UNICEF, UNHCR, WHO and the local NGOs in order to expand the scope and coverage of their efforts from 18% of the adolescent population to national coverage. The African Youth Alliance project has six main programme areas:
Program Management and Implementation Modalities This program is a collaborative effort between the Government of Uganda and the Alliance with Adolescents for sexual and Reproductive Health composed of United Nations Population Fund (UNFPA), PATH, Pathfinder International. Target group: All Adolescents. Out of schools adolescents, provided with the behaviour change, communication intervention including accurate and appropriate ASRH information, life skills education and vocational skills through youth centres. YOUTH ALIVE The organisation started in 1993. Coverage:
Activities:
Target group: Mainly;
Achievements
- Life skills to the young people/youth below 12 years on relationship building and providing information on AIDS. - Have spread to other countries e.g. Zambia, Zimbabwe, Kenya, Tanzania, South Africa and Botswana. Constraints
- Follow up especially to those who have left the school and they did not come back to help in evaluation.
Lack of focussed resource materials being a new area demand is too much therefore is hard to meet the services of the beneficiaries.
ACFODE ( Action for Development) General coverage: ACFODE operates in districts of;
And any other district for outreach programmes. Project Specific for Adolescent Reproductive Health Currently it has two running projects in the districts of;
Coverage Three (3) subcounties in Kasilo county e.g. Bugondo, Kadungulu, Pingere 30 schools are covered that is 2 secondary schools and 28 primary schools. Why operate in Soroti?: Research was done in Soroti and findings showed;
Constraints
Future Plans
|