MANY adolescents lack information and services to help them understand their sexual and reproductive health issues. The resulting problems are sexually transmitted diseases, including HIV, early pregnancies, poor hygiene, abuse of alcohol and tobacco, unwarranted risk taking and destructive activity.
The Uganda Demographic and Health Survey 2006 indicates that 24% of Ugandan girls have had sexual intercourse by the age of 15 and the teenage pregnancy rate is at 24%. Pregnancy is a significant cause of death for girls aged 15-19, with complications of child birth and unsafe abortion being the major factors. An estimated 297,000 induced abortions are performed every year in Uganda, according to the Guttmacher Institute Study on unintended pregnancy and induced abortion in Uganda.
The poor state of reproductive health profile among the young people is often caused by lack of adolescent friendly services. Unfortunately, their reproductive health needs have been largely ignored.
However, adolescents in some parts of the country have benefited from such services through projects. But there are few or even no models of youth friendly services that are self-sustaining. Many of them rely on donor funding for survival.
A major consideration in the development and scaling up of adolescent-friendly services is the need for long-term investment by the Government and/or international donors.
Sustainability is the ability of an institution to continue providing quality services and products for the young people, even when donors phase out.
Any reproductive health programme for the adolescents deserves to be sustainable. Such a programme is able to continue with its activities and meet its objectives every year, to make plans for the future and carry them out, despite changes in the external context.
However, reproductive health programmes for the adolescents are challenging because they operate in an ever changing environment. Apart from changes in source and level of funding, the consumers’ demands are also ever changing.
In the public sector, programmatic sustainability can be enhanced by the Government allocating funding and continuous support for provision of quality services. Existent policies supporting the provision of youth- friendly services should be strengthened. Adolescents should be involved in the design, implementation and evaluation of programmes.
In both public and private programmes, ensuring satisfaction of the young people is important for increasing demand for the services.
Institutional sustainability can be achieved when there is sufficient political commitment, support and resources to ensure that services will continue to be offered.
The planning systems should consciously support the design and implementation of appropriate strategies for improved reproductive health, while the logistics system should provide the inputs needed for programmes and a management information system to monitor programme performance.
Health workers should be provided with specific training to be able to communicate with adolescents and to build competence in handling their health concerns.
The Government should create partnerships premised on co-responsibility with participating agencies. Partnering with the Government to provide adolescent-friendly services affords non-government organisations several advantages.
Government health programmes reach a large portion of the population and often provide services to rural and disadvantaged communities that are difficult for smaller agencies to reach.
On the other hand, sexual and reproductive health organisations often provide expertise and knowledge needed by public sector workers.
Above all, adolescent health programmes and policies should be interdisciplinary and reach beyond the health sector. Efforts should be scaled up to adequately confront the enormous health challenges facing adolescents.
The writer is the programme officer of Health and Nutrition
SAO-Uganda
