On November 6, 2017, the Mbarara district chief administrative officer (CAO) then , Fred Kalyesubura, issued a directive to all health facilities to dedicate a specific day to provide youth-friendly health services. The services must include family planning.
Advance Family Planning (AFP) local partner Reproductive Health Uganda (RHU) led the advocacy to achieve this significant development in Mbarara district, where 48% of the population is under the age of 18 (National Population Census Report 2016).
RHU integrated the AFP SMART approach with social accountability methods—a first for them. Social accountability work is built on the philosophy that when equipped with knowledge of their rights, critical awareness, and the space to participate, young people are able to hold duty bearers accountable for providing much needed services, including health and family planning.
In September 2017, RHU facilitated sessions to train young people on social accountability and their health rights and responsibilities. RHU worked with 20 young people in Mbarara and Bushenyi districts, equipping them with skills on how to use the social accountability tools—including RHU’s adaptation of the Care International Community Score Card.
The score card empowers communities to participate in providing essential information and constructive feedback.
Following RHU’s social accountability training, the youth participants visited health facilities in Mbarara and Bushenyi districts to converse with other young people and community members. Using the community score card, the young facilitators assessed youth access to health services, including family planning, based on a scale of 1 to 5 (very bad; bad; fair; good; and very good).
The score card exercise identified a number of issues, including: poor provision of youth-friendly services, little respect for young people from health workers, under-staffing, and limited resources for youth-focused outreaches. With the evidence from the score card, RHU facilitated an AFP SMART strategy session with the 20 young people from Mbarara and Bushenyi districts in October 2017.
The Mbarara district team developed two objectives during that session:
- Mbarara district council passed a resolution to allocate specific times for provision of youth friendly services at all health centers by November 2017, and:
- Mbarara district council created a budget line and allocates funds for youth friendly services in the health sector budget by May 2018.
Subsequently, RHU facilitated meetings between young people and their district leaders where the young people presented the score card results and advocated directly to Mbarara leadership to take action.
That same month, the District Technical Planning Committee endorsed the creation of specific times for provision of youth-friendly health services, including family planning. The committee referred the issue of creating a budget line for youth-friendly services in the district’s health sector budget to the district council meeting in December 2017.
All heath facilities are instructed to implement the directive for youth-friendly health services and inform the CAO’s office of the selected day. The district health office is tasked to follow up on adherence and provide monthly reports.
RHU will continue to follow up on the implementation of this directive and the ongoing advocacy for a youth friendly service provision budget allocation. RHU will also keep supporting the youth advocates in Bushenyi district with their ongoing social accountability work.
Achieving good reproductive health remains a far-off goal in many parts of the world. This lack of care has repercussions. An estimated 830 women die of pregnancy-related causes each day, amounting to more than 300,000 deaths each year; 99% of these deaths occur in low- and middle-income countries.