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Kusoma Haraka Wakati wa Kusoma: 5 dakika

AYSRH nchini Uganda Wakati wa Janga la COVID-19

Ensuring provision and access to information, huduma, and commodities

Janga la COVID-19 limetatiza maisha ya vijana na vijana katika jamii zote za Uganda kwa njia nyingi.. Na wimbi la kwanza la COVID-19 mnamo Machi 2020 kulikuja kupitishwa kwa hatua za kuzuia, such as the closure of schools, movement restrictions, and self-isolation. Matokeo yake, the health and well-being of young people, especially adolescent and youth sexual and reproductive health (AYSRH) nchini 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, kama:

  • 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.
Mhudumu wa afya ya jamii wakati wa ziara ya nyumbani, kutoa huduma za uzazi wa mpango na chaguzi kwa wanawake katika jamii. Mikopo: Jonathan Torgovnik/Getty Picha/Picha za Uwezeshaji.

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%).

Kwa sababu hizi, the already alarming rate of teenage pregnancies (25%) drastically increased. Other catalytic factors (adolescents and young women engaging in transactional sex for basic needs, unyanyasaji wa kijinsia, 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. Zaidi ya hayo, 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 measuresThese 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 kupatikana kwamba 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, wakati 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, wizara ya afya (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. Haya, 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 (bonyeza ili kupanua)

  • 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 (bonyeza ili kupanua)

  • *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.
  • Kujitunza: 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 (bonyeza ili kupanua)

  • HIV self-testing.
  • Self-injectable contraceptives.
  • Utilization of enabling tools and platforms, such as online pharmacies.
  • Encouragement of multi-month supply of some kujijali bidhaa.
  • 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 (bonyeza ili kupanua)

  • Kondomu.
  • 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. Mikopo: Jonathan Torgovnik/Getty Picha/Picha za Uwezeshaji.

Looking Forward in the New Normal

The MOH, development and implementing partners, cultural and religious leaders, wazazi, 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, vijana, wanawake na wasichana, 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 nchini Uganda Wakati wa Janga la COVID-19
Precious Mutoru, MPH

Advocacy & Partnerships Coordinator, Huduma za Kimataifa za Idadi ya Watu

Precious ni mtaalamu wa afya ya umma na mtetezi dhabiti wa afya na ustawi wa jamii kote ulimwenguni., kwa maslahi makubwa katika afya ya ngono na uzazi na usawa wa kijinsia. Na uzoefu wa karibu miaka mitano katika uzazi, afya ya uzazi na vijana, Precious ana shauku kubwa ya kubuni masuluhisho yanayowezekana na endelevu kwa masuala mbalimbali ya afya ya uzazi na kijamii yanayoathiri jamii nchini Uganda., kupitia miundo ya programu, mawasiliano ya kimkakati na utetezi wa sera. Kwa sasa, anahudumu kama mratibu wa utetezi na ushirikiano katika shirika la People Services International - Uganda, ambapo anashirikiana na washirika katika bodi kutekeleza malengo yatakayokuza ajenda ya uzazi wa mpango na afya ya uzazi kwa upana nchini Uganda.. Precious anajiunga na shule ya mawazo ambayo inasisitiza kwamba kuboresha afya na ustawi wa watu nchini Uganda na duniani kote.. Zaidi ya hayo, yeye ni mhitimu wa Global Health Corps, bingwa wa kujitunza kwa afya ya ngono na uzazi na usimamizi wa maarifa nchini Uganda. Ana MSc. katika Afya ya Umma kutoka Chuo Kikuu cha Newcastle - Uingereza.

Dk. Ben Kibirige

Advocacy Manager, Foundation For Male Engagement Uganda

Dk. 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 Snowman

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) nchini 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) utekelezaji wa programu, utafiti, 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, uundaji wa sera, and lasting change.

Alex Omari

Afisa wa KM wa Afrika Mashariki, Maarifa MAFANIKIO, Amref Afya Afrika

Alex ni Afisa wa Kiufundi wa Upangaji Uzazi/Afya ya Uzazi katika Taasisi ya Amref Health Africa ya Ukuzaji Uwezo.. Anafanya kazi kama Afisa wa Usimamizi wa Maarifa wa Mkoa (Afrika Mashariki) kwa mradi wa Maarifa SUCCESS. Alex amekwisha 8 uzoefu wa miaka katika vijana na vijana afya ya ngono na uzazi (AYSRH) muundo wa programu, utekelezaji, utafiti, na utetezi. Kwa sasa ni mshiriki wa Kikundi cha Kufanya Kazi cha Kiufundi cha mpango wa AYSRH katika Wizara ya Afya nchini Kenya. Alex ni mshiriki aliyechaguliwa wa Jumuiya ya Kifalme ya Afya ya Umma (FRSPH) na aliyekuwa Mratibu wa Nchi wa Kenya kwa Muungano wa Kimataifa wa Vijana wa Upangaji Uzazi (IYAFP). Ana Shahada ya Kwanza ya Sayansi (Afya ya Watu) na Mwalimu wa Afya ya Umma (Afya ya Uzazi) kutoka Chuo Kikuu cha Kenyatta, Kenya. Kwa sasa anasomea shahada yake ya pili ya Uzamili katika Sera ya Umma katika Shule ya Serikali na Sera ya Umma (SGPP) huko Indonesia ambapo pia ni msomi wa uandishi wa sera za afya na afya ya umma na mchangiaji wa tovuti kwa Jarida la Mapitio ya Kimkakati.

Sarah Kosgei

Meneja wa Mitandao na Ubia, Amref Afya Afrika

Sarah ni Meneja Mitandao na Ubia katika Taasisi ya Ukuzaji Uwezo. Amemaliza 10 uzoefu wa miaka mingi wa kutoa uongozi kwa programu za nchi nyingi zinazolenga kuimarisha uwezo wa mfumo wa afya kwa afya endelevu katika Mashariki., Kati, na Kusini mwa Afrika. Yeye pia ni sehemu ya sekretarieti ya Women in Global Health - Africa Hub inayomilikiwa na Amref Health Africa, Sura ya Kikanda ambayo hutoa jukwaa la majadiliano na nafasi ya ushirikiano kwa uongozi wa mabadiliko ya kijinsia ndani ya Afrika. Sarah pia ni mwanachama wa Huduma ya Afya kwa Wote (UHC) Rasilimali Watu kwa Afya (HRH) kamati ndogo nchini Kenya. Ana digrii katika Afya ya Umma na Shahada ya Uzamili katika Utawala wa Biashara (Afya Ulimwenguni, Uongozi na Usimamizi). Sarah ni mtetezi mwenye shauku wa huduma ya afya ya msingi na usawa wa kijinsia katika Afrika Kusini mwa Jangwa la Sahara.

Irene Alenga

Usimamizi wa Maarifa na Kiongozi wa Ushirikiano wa Jamii, Kiongeza kasi cha Utetezi

Irene ni mwanauchumi wa kijamii aliyeimarika na mwenye zaidi 13 uzoefu wa miaka katika utafiti, uchambuzi wa sera, usimamizi wa maarifa, na ushiriki wa ushirikiano. Kama mtafiti, amehusika katika uratibu na utekelezaji wa juu 20 miradi ya utafiti wa kiuchumi wa kijamii katika taaluma mbalimbali ndani ya Ukanda wa Afrika Mashariki. Katika kazi yake kama Mshauri wa Usimamizi wa Maarifa, Irene amekuwa akijihusisha na masomo yanayohusiana na afya kupitia kazi na taasisi za afya ya umma na teknolojia nchini Tanzania, Kenya, Uganda na Malawi ambapo amefaulu kudhihaki hadithi za athari na kuongeza mwonekano wa afua za mradi. Utaalam wake katika kukuza na kusaidia michakato ya usimamizi, masomo yaliyopatikana, na mbinu bora zaidi zinatolewa mfano katika usimamizi wa mabadiliko ya shirika wa miaka mitatu na mchakato wa kufunga mradi wa USAID| DELIVER na Mifumo ya Usimamizi wa Ugavi (SCMS) 10-mradi wa mwaka nchini Tanzania. Katika mazoezi yanayoibuka ya Ubunifu uliozingatia Binadamu, Irene amefaulu kuwezesha mwisho chanya wa kumaliza matumizi ya bidhaa kupitia kufanya tafiti za uzoefu wa mtumiaji huku akitekeleza USAID| Mradi wa DREAMS miongoni mwa wasichana balehe na wanawake vijana (AGYWs) nchini Kenya, Uganda, na Tanzania. Irene anafahamu vyema uhamasishaji wa rasilimali na usimamizi wa wafadhili, hasa na USAID, DFID, na EU.

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