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.
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 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.
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.
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