Research on Adolescent Sexual and
Reproductive Health in Uganda

CONCLUSIONS

CONCLUSION AND LESSONS LEARNT

This was an assessment of studies that were done and programmes/projects being implemented on ASRH. A number of stakeholders: Government, bilateral agencies, NGOs and CBOs have tried to address sexual and reproductive health of adolescents in Uganda. The review has showed that adolescent sexual and reproductive health needs a concerted effort among these stakeholders. Despite the services delivery and behavioral change interventions the RH status of most adolescents in the country needs to be addressed. Lessons have been learnt from some programmes interventions that have been used to promote healthy behaviour among the youth.

Coverage

The programs have tried to reach the youth both in rural and urban areas. However the coverage is still limited. Some of the districts have not been reached. The programs reach less than half of Uganda’s districts. That means few adolescents are currently reached. Most projects/programs on adolescents reviewed have targets few districts, and if they have gone any deeper they have reached at few selected sub-county levels. Others are based in urban areas and the deep rural areas where majority of adolescents who need SRH services live are left out. By region the northern and northeastern part of Uganda has been scantly covered. This has also been reflected in the literature review.

Ongoing activities seem to be fragmented and uncoordinated. Co-ordination and sharing of information and strategies among stakeholders in ASRH is still limited.

Service delivery factors

• Most services are not friendly to adolescents in terms of services, environment, personnel, hours of service, alternative ASRH services available etc. some agencies are trying to make some services friendly but this is just the tip of the iceberg.

• Health care services are still inadequate. Health centers and hospitals have a lot to be desired. They’re inadequate health supplies such as drugs for STDs, condoms and contraceptives. Stock outs have been common phenomena in many health centers where adolescents go for treatment. This also applies to basic equipment and clinical expendable supplies for RH. Clients do not see the reason to travel distances to come to the units that have scarcity of such basic items. The referral system is not fully streamlined. Accessibility of services in terms of affordability is one disincentive for uptake of services. In health facilities where they pay a fee for instance for family planning services, adolescent may not access the services due to financial constraints. This was reflected a number of studies reviewed.

• IEC materials on RH for adolescents have not been adequate in terms of quantity, quality and types/choices.

Other barriers to practice safer sex (condom use, abstinence) included misinformation, inaccuracies and myths. Peer influence is also a factor making adolescent do what their peers are doing e.g. indulging in sex.

The environment adolescents live in some times is not supportive. The negative parental, religious, community attitudes towards unmarried adolescents seeking RH services is also a barrier to access the services by adolescents. The parents may stop adolescents from using such services.

There was minimal focus on the following areas affecting ASRH:

• Adolescents in especially difficult circumstances such as the internally displaced, refugees and adolescents in child headed household.

• Teenage adolescent mothers have almost been left out in most of the adolescent RH interventions, yet they need top be empowered with adequate information and support.

• The emerging trend of drug and substance abuse especially among adolescent boys needs to be thoroughly investigated. The implications of drug and substance on adolescent health need to be ascertained.

• There has been minimal adolescent participation/involvement

In planning for interventions most programs involved adolescents as clients.

• Younger adolescents (10-14 years) are difficult to target.

• Adolescent are poor at negotiating reproductive outcomes

• Resource mobilization and management is important. A number of NGOs reported financial constraints that led to delays in executing planned activities. With decentralization and cost sharing districts need to be equipped with the capacity to resource and manage funds for sustainability.

• A number of ASRH interventions in the country have not been evaluated to assess positive and negative effect so as to addresses the emerging ASRH issues critically. By knowing more about what works in youth programmes and services stakeholders can build a strong program that accomplish what they intend.

Intervention Strategies that seemed to be successful that AFRICA ALIVE should borrow a leaf from include:

• Stakeholders sharing experiences and resources such as technical and IEC materials depicted by the NGO track program and other agencies.

• A combination of behavioral change, IEC interventions would work well if accompanied by service delivery such as the Naguru teenage center approach or referral system that is working and a follow-up of clients.

• Peer education approach as used by PEARL and other agencies would enhance participation and acceptance by adolescents

• Success of programs e.g. school based may depend on the commitment of other stakeholders at the district, community and school. Sustainability of project may depend on the commitment of the district, communities and beneficiaries.

• There are growth-related problems typical to any growing/new NGO/project. The Project should not take on many activities before capacity is built and enhanced for the staff in terms of administration, financial and service delivery.

Recommendations based on gaps identified:

• There is need for a coordinating body that brings together stakeholders: Ministries, agencies, NGOs involves in ASRH to develop more effective intervention strategies to meet adolescents needs in a cost effective and efficient way, to avoid duplication of resources and functions.

• Service providers need to be trained for Adolescent friendly Service. The training should not only emphasis RH but also other pertinent issues of adolescence such a relationships, hygiene, peer pressure etc.

• Adolescent friendly environment should be created to attract adolescents more especially the females.

• There is need for programs to address the hard to reach adolescents and get female adolescents back to school once they drop out due to pregnancy.

• Sustainability question is important even when the project is being designed. The district, community and beneficiaries if they were involved at the inception period would feel the ownership and may suggest ways of sustaining the program.

• HIV/AIDS interventions for adolescents should not only end at giving knowledge; rather attempts should be made address other psychosocial issues that greatly influence behavior.

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