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AYSRH in Uganda During the COVID-19 Pandemic

Ensuring provision and access to information, services, and commodities

The COVID-19 pandemic has disordered the livelihoods of adolescents and young people across Uganda’s communities in many ways. With the first COVID-19 wave in March 2020 came the adoption of containment measures, such as the closure of schools, movement restrictions, and self-isolation. As a result, the health and well-being of young people, especially adolescent and youth sexual and reproductive health (AYSRH) in Uganda, took a hit.

Impact of COVID-19 on AYSRH

Research suggests that the efforts aimed at managing the COVID-19 pandemic de-emphasized the provision of other essential services, such as those relating to an individual’s SRH. The selective prioritization of some of these services left individuals, particularly adolescents and young people, with no means of making informed decisions and maintaining their health.

Adolescents and young people often access health-related information in discreet ways, like:

  • From schools.
  • Youth-friendly corners in health facilities.
  • Through peer educators.

The closure of some of these avenues and restrictions in movement meant that adolescents and young people could not utilize these services—in addition to an already restrictive and unresponsive policy and operational environment that includes:

  • Negative perceptions about access to contraceptives for adolescents and young people.
  • Poor provider attitude.
  • The moralization of sexual and reproductive health (SRH).
  • Unfriendly and high costs of services.

These greatly hinder the improvement of AYSRH in Uganda.

Community health worker during a home visit, providing family planning services and options to women in the community. Credit: Jonathan Torgovnik/Getty Images/Images of Empowerment.
Community health worker during a home visit, providing family planning services and options to women in the community. Credit: Jonathan Torgovnik/Getty Images/Images of Empowerment.

The Makerere School of Public Health surveyed the impact of COVID-19 on access to family planning services and unintended pregnancies. It indicated that individuals failed to obtain and utilize family planning and other SRH health services due to:

  • Movement restrictions (9%).
  • Closure of health facilities (17%).
  • Fear of contracting the virus (49%).
  • Family would not allow due to COVID-19 (13%).

For these reasons, the already alarming rate of teenage pregnancies (25%) drastically increased. Other catalytic factors (adolescents and young women engaging in transactional sex for basic needs, sexual assault, forced marriage for economic benefits to avert COVID-19-related poverty) aided the increase. Some regions, like the Acholi sub-region, which reported over 17,000 pregnancies, recorded more adolescents and young women procuring abortions. These procedures were predominantly unsafe. Additionally, a significant portion of adolescent girls and boys re-evaluated their continuation of school.

The confirmation of the second wave of the COVID-19 pandemic brought a series of containment measures like those implemented during the first wave. These spell doom for already vulnerable adolescents and young people and could deter Uganda’s progress toward achieving its demographic dividend phase.

“The confirmation of the second wave of the COVID-19 pandemic brought a series of containment measures…These spell doom for already vulnerable adolescents and young people.”

The Cross-Sectional Study on the Sexual and Reproductive Health Challenges Among Young People During the COVID-19 Lockdown found that 28% of young people reported that they did not have access to information and/or education concerning SRH. More than a quarter of participants (26.9%) reported that testing and treatment services of sexually transmitted infections were not available during the lockdown, while 27.2% of the respondents could not obtain contraceptive supplies.

Improving AYSRH in Uganda in the Context of COVID-19

Even as the government refines the measures for plateauing the COVID-19 pandemic curve, the Ministry of Health (MOH) has teamed up with implementing partners in the reproductive health realm in Uganda. They have adopted various innovative strategies for continued provision and access to SRH services and information. These, if scaled up across Uganda and other countries, could potentially contend with the effects of COVID-19 on AYSRH and salvage the gains registered over the years.

  • Adoption of guidelines and frameworks to guide service delivery in the context of COVID-19: The Adolescent Health Division at the MOH collaborated with key stakeholders and implementing partners. They developed and adopted guidelines for the continuity of SRH service provision for adolescents and young people in the context of COVID-19.

Guideline Proposals (click to expand)

  • The use of technology to share information on available SRHR services and access points.
  • Guidance on task sharing/shifting at health facilities.
  • Directives on health service delivery interventions.
  • Leadership interventions.
  • Strategies for sustainable financing interventions.
  • Infrastructure and commodity security interventions.
  • Utilization of digital tools: With school closures and movement restrictions, most adolescents and young people utilized digital tools/online platforms more than usual for school learning, social activities, and general information. Partners in Uganda leveraged this opportunity to share information on SRH, provide counseling, and link users to online pharmacies.

Examples of Tools and Platforms (click to expand)

  • *284*15#—USSD code that facilitates access to SRHR information through text.
  • Toll-free line Salt Helpline.
  • Phone apps like Sauti Plus.
  • Dedicated TV channels like Sauti TV as well as social media platforms.
  • Self-care: Maintaining health and preventing illness during the lockdown required individuals to rely on their abilities. They utilized information and health commodities available to them, with limited interaction with the health system.

Self-Care Interventions for SRHR Popularized by the MOH and Partners (click to expand)

  • HIV self-testing.
  • Self-injectable contraceptives.
  • Utilization of enabling tools and platforms, such as online pharmacies.
  • Encouragement of multi-month supply of some self-care commodities.
  • Leveraging the private sector’s reach and platforms: The MOH, in collaboration with development and implementing partners, identified opportunities within the private sector to continue providing SRH services. One of the private companies identified was Safe Boda, a motorbike transport company with a massive reach in the Kampala metropolitan area and neighboring towns. The transport company uses a digital application to coordinate client pickups and drop-offs. It was updated to include an e-shop to facilitate online purchase and delivery of reproductive health products.

E-shop’s Reproductive Health Products (click to expand)

  • Condoms.
  • Contraceptive pills.
  • HIV test kits.
  • Pregnancy test kits.
  • Mama Kits (clean delivery kits).

This innovation enabled individuals, including adolescents and young people, to access products in the comfort of their homes. Similar interventions included the use of regular commercial Boda Bodas (motorcyclists) to distribute reproductive health products from pharmacies and drug shops (chemists) to clients.

  • Social-behavioral change—integrating COVID-19 and SRHR messaging: The MOH and district health teams collaborated with partners to design and integrate targeted messages on SRH. These stakeholders utilized the same communication channels to share information on COVID-19 and SRH. Some partners worked with the district-level COVID-19 task forces and supported the team with hiring megaphones for sharing COVID-19 information across communities—encouraging individuals to seek SRH services and information. The Kampala metropolitan area saw collaboration among the Capital City Authority to design and share messages through mobile media vans, especially in the urban poor communities. Partners also ensured the inclusion of peers and youth leaders within these tasks teams to support responses to adolescents’ and young people’s needs.
  • Layering service provision and leveraging existing structures: The MOH and its partners utilized already existing health service provision structures. They used community service points for HIV/AIDS care and immunization to layer SRH services for individuals, including adolescents and young people.
Phoebe Awuco (orange & white top), a community mobilizer and head of the Self Help Women Group Alita Kole, at her home with her orphan grandchildren. Credit: Jonathan Torgovnik/Getty Images/Images of Empowerment.
Phoebe Awuco (orange & white top), a community mobilizer and head of the Self Help Women Group Alita Kole, at her home with her orphan grandchildren. Credit: Jonathan Torgovnik/Getty Images/Images of Empowerment.

Looking Forward in the New Normal

The MOH, development and implementing partners, cultural and religious leaders, parents, and community individuals recommended:

  • Fast-tracking the finalization and dissemination of a continuity strategy for SRHR information and service provision for adolescents and young people, thus encouraging prioritization of the needs of this unique population.
  • Partners ensure continuity in the provision of SRH information and services for adolescents and young people as a complementary effort to the MOH programs.
  • CSOs/Taskforces provide PPE items to peers in the community to protect them from contracting COVID-19 as they do the door-to-door visits to identify and support responses to SRH needs.
  • Including young people in the COVID-19 task force and on the team of village health team workers, to facilitate targeted focus on adolescents and young people.
  • Consultation with organizations and movements of adolescents, young people, women and girls, and young people living in vulnerable situations on a regular and inclusive basis to guarantee considerations throughout the creation of tailored COVID-19 responses.
  • Invest funding to facilitate scale-up of innovations that yielded most results in reaching the adolescents and young people and supporting them during the lockdowns, while being mindful of innovations such as the digital and tech platforms that are likely to cause inequities.

The government should integrate SRH within COVID-19 and emergency response. To mitigate poor SRH outcomes because of the pandemic lockdown, it should be recognized as an essential service. This is critical for adolescents and young people (especially low-income young women and girls) who are mainly disadvantaged.

AYSRH in Uganda During the COVID-19 Pandemic
Precious Mutoru, MPH

Advocacy & Partnerships Coordinator, Population Services International

Precious is a public health professional and a thought-strong advocate for the health and wellbeing of communities across the globe, with a keen interest in sexual and reproductive health and gender equality. With nearly five years’ experience in reproductive, maternal and adolescent health, Precious is enthusiastic about innovating feasible and sustainable solutions to the various reproductive health and social issues affecting communities in Uganda, through program designs, strategic communications and policy advocacy. Currently, she is serving as an advocacy and partnerships coordinator at population Services International – Uganda, where she is collaborating with partners across the board to pursue objectives that will promote the agenda for family planning and reproductive health broadly in Uganda. Precious subscribes to the school of thought that insists that improving the health and wellbeing of populations in Uganda and across the globe. Additionally, she is a Global Health Corps alum, a champion for self-care for sexual and reproductive health and knowledge management in Uganda. She holds an MSc. in Public Health from the University of Newcastle – United Kingdom.

Dr. Ben Kibirige

Advocacy Manager, Foundation For Male Engagement Uganda

Dr. Kibirige is a medical doctor by profession, women’s rights activist, sexual reproductive health rights (SRHR) consultant, and master trainer accredited by Makerere School of Public Health. He has over four years of experience advocating for family planning-related programs and inclusive SRHR service provision to all young people. He also advocates for gender equality, women's rights, and quality and affordable health care for young girls and women through meaningful youth participation in national development processes.​ Dr. Kibirige is currently the general secretary for the SHE DECIDES Uganda local movement and the alternate steering committee representative for Men Engage Network in Uganda. He is a co-founder of Centre for Young Mothers’ Voices, a local NGO advocating for the rehabilitation and reintegration of teenage mothers back into mainstream social life.

Tonny Muzira

Advocacy and Partnerships Officer, Foundation For Male Engagement Uganda

Tonny is the advocacy and partnerships officer at Foundation for Male Engagement Uganda. He is a public health practitioner and sexual reproductive health and rights (SRHR) specialist with seven years of experience in the design and implementation of SRHR among young people in Uganda. He is the current chairperson of the Youth4UHC movement in Africa as well as a member of the UNFPA Youth technical working group on Population, SRHR, and Climate change. Tonny is a former country coordinator for the International Youth Alliance for Family Planning (IYAFP) in Uganda.

Norah Nakyegera

Advocacy and Campaign Officer, Uganda Youth and Adolescent Health Forum (UYAHF)

Norah Nakyegera is a women's rights activist who is committed to advocating for and promoting the sexual reproductive health rights of adolescents and young people. Norah has over two years of experience in adolescent and youth sexual and reproductive health (AYSRH) program implementation, research, and advocacy.​ She strongly advocates for gender equality, women's rights, quality and affordable health care for young girls and women, and the meaningful participation of young people in the national development processes.​ Currently, she is the advocacy and campaigns officer at the Uganda Youth and Adolescent Health Forum. Her ultimate goal is to create a grassroots movement that understands and values human rights and takes responsibility for respecting, defending, and promoting human rights.​ She is also a member of the Global Shapers Community (an initiative by the World Economic Forum), where young people are central to solution building, policymaking, and lasting change.

Alex Omari

East Africa KM Officer, Knowledge SUCCESS, Amref Health Africa

Alex is the Technical Family Planning/Reproductive Health Officer at Amref Health Africa’s Institute of Capacity Development. He works as the Regional Knowledge Management Officer (East Africa) for the Knowledge SUCCESS project. Alex has over 8 years’ experience in adolescent and youth sexual and reproductive health (AYSRH) program design, implementation, research, and advocacy. He is currently a Technical Working Group member for the AYSRH program at the Ministry of Health in Kenya. Alex is an elected Fellow of the Royal Society for Public Health (FRSPH) and a former Kenya Country Coordinator for the International Youth Alliance for Family Planning (IYAFP). He holds a Bachelor of Science (Population Health) and a Master of Public Health (Reproductive Health) from Kenyatta University, Kenya. He is currently pursuing his second Master's degree in Public Policy at the School of Government and Public Policy (SGPP) in Indonesia where he is also a public health and health policy writing scholar and website contributor for the Strategic Review Journal.

Sarah Kosgei

Networks and Partnerships Manager, Amref Health Africa

Sarah is the Networks and Partnerships Manager at the Institute of Capacity Development. She has over 10 years’ experience providing leadership to multi-country programs geared towards strengthening the capacity of the health system for sustainable health in Eastern, Central, and Southern Africa. She also part of the Women in Global Health – Africa Hub secretariat domiciled at Amref Health Africa, a Regional Chapter that provides a platform for discussions and a collaborative space for gender-transformative leadership within Africa. Sarah is also a member of the Universal Health Coverage (UHC) Human Resources for Health (HRH) sub-committee in Kenya. She has degrees in Public Health and an Executive Masters in Business Administration (Global Health, Leadership and Management). Sarah is a passionate advocate for primary health care and gender equality in sub-Saharan Africa.

Irene Alenga

Knowledge Management and Community Engagement Lead, Advocacy Accelerator

Irene is an established social economist with over 13 years’ experience in research, policy analysis, knowledge management, and partnership engagement. As a researcher, she has been involved in the coordination and implementation of over 20 social economic research projects in various disciplines within the Eastern African Region. In her work as a Knowledge Management Consultant, Irene has been involved in health-related studies through work with public health and technology-focused institutions in Tanzania, Kenya, Uganda and Malawi where she has successfully teased out impact stories and increased visibility of project interventions. Her expertise in developing and supporting management processes, lessons learned, and best practices is exemplified in the three-year organizational change management and project closure process of the USAID| DELIVER and Supply Chain Management Systems (SCMS) 10-year project in Tanzania. In the emerging practice of Human Centered Design, Irene has successfully facilitated a positive end to end product experience through conducting user experience studies while implementing the USAID| DREAMS Project amongst adolescent girls and young women (AGYWs) in Kenya, Uganda, and Tanzania. Irene is well-versed in resource mobilization and donor management, especially with USAID, DFID, and EU.

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