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AYSRH sa Uganda Sa panahon ng COVID-19 Pandemic

Ensuring provision and access to information, mga serbisyo, and commodities

Ang pandemya ng COVID-19 ay gumulo sa kabuhayan ng mga kabataan at kabataan sa mga komunidad ng Uganda sa maraming paraan. Sa unang COVID-19 wave noong Marso 2020 dumating ang pagpapatibay ng mga hakbang sa pagpigil, such as the closure of schools, movement restrictions, and self-isolation. Ang resulta, 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, gusto:

  • 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/Mga Larawan ng 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%).

Para sa mga kadahilanang ito, 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. Bukod pa rito, 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.”

Ang 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, ang 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. Ang mga ito, 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.
  • Pangangalaga sa sarili: 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 pangangalaga sa sarili 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)

  • Mga condom.
  • 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/Mga Larawan ng Empowerment.

Looking Forward in the New Normal

The MOH, development and implementing partners, cultural and religious leaders, magulang, 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, mga kabataan, babae at babae, 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.

Mga miyembro ng Muvubuka Agunjuse youth club. Credit: Jonathan Torgovnik/Getty Images/Mga Larawan ng Empowerment
Mahal na Mutoru, MPH

Advocacy & Partnerships Coordinator, Mga Serbisyo sa Populasyon Internasyonal

Si Precious ay isang propesyonal sa kalusugan ng publiko at isang matibay na tagapagtaguyod para sa kalusugan at kagalingan ng mga komunidad sa buong mundo, na may matinding interes sa kalusugang sekswal at reproductive at pagkakapantay-pantay ng kasarian. Sa halos limang taong karanasan sa reproductive, kalusugan ng ina at kabataan, Si Precious ay masigasig tungkol sa pagbabago ng mga magagawa at napapanatiling solusyon sa iba't ibang mga isyu sa kalusugan ng reproduktibo at panlipunan na nakakaapekto sa mga komunidad sa Uganda, sa pamamagitan ng mga disenyo ng programa, estratehikong komunikasyon at pagtataguyod ng patakaran. Kasalukuyan, siya ay nagsisilbi bilang isang advocacy at partnerships coordinator sa population Services International – Uganda, kung saan siya ay nakikipagtulungan sa mga kasosyo sa buong board upang ituloy ang mga layunin na magsusulong ng agenda para sa pagpaplano ng pamilya at kalusugan ng reproduktibo sa Uganda. Si Precious ay nag-subscribe sa paaralan ng pag-iisip na iginigiit na ang pagpapabuti ng kalusugan at kagalingan ng mga populasyon sa Uganda at sa buong mundo. Bukod pa rito, isa siyang alum ng Global Health Corps, isang kampeon para sa pangangalaga sa sarili para sa kalusugang sekswal at reproductive at pamamahala ng kaalaman sa Uganda. May hawak siyang MSc. sa Pampublikong Kalusugan mula sa Unibersidad ng Newcastle – United Kingdom.

Sinabi ni Dr. Ben Kibirige

Advocacy Manager, Foundation For Male Engagement Uganda

Sinabi ni 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 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) 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) pagpapatupad ng programa, pananaliksik, 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, paggawa ng patakaran, and lasting change.

Alex Omari

Opisyal ng KM ng East Africa, Kaalaman TAGUMPAY, Amref Health Africa

Si Alex ay ang Technical Family Planning/Reproductive Health Officer sa Amref Health Africa's Institute of Capacity Development. Nagtatrabaho siya bilang Regional Knowledge Management Officer (Silangang Aprika) para sa proyekto ng Knowledge SUCCESS. Tapos na si Alex 8 taon na karanasan sa kalusugang sekswal at reproduktibo ng kabataan at kabataan (AYSRH) disenyo ng programa, pagpapatupad, pananaliksik, at adbokasiya. Siya ay kasalukuyang miyembro ng Technical Working Group para sa programa ng AYSRH sa Ministry of Health sa Kenya. Si Alex ay isang nahalal na Fellow ng Royal Society for Public Health (FRSPH) at isang dating Kenya Country Coordinator para sa International Youth Alliance para sa Family Planning (IYAFP). Siya ay may hawak na Bachelor of Science (Kalusugan ng Populasyon) at isang Master of Public Health (Reproductive Health) mula sa Kenyatta University, Kenya. Kasalukuyan niyang hinahabol ang kanyang pangalawang Master's degree sa Public Policy sa School of Government and Public Policy (SGPP) sa Indonesia kung saan isa rin siyang iskolar sa pagsulat ng patakaran sa kalusugan at kalusugan ng publiko at taga-ambag sa website para sa Strategic Review Journal.

Sarah Kosgei

Tagapamahala ng Networks and Partnerships, Amref Health Africa

Si Sarah ang Networks and Partnerships Manager sa Institute of Capacity Development. Tapos na siya 10 taon na karanasan sa pagbibigay ng pamumuno sa mga programang maraming bansa na nakatuon sa pagpapalakas ng kapasidad ng sistema ng kalusugan para sa napapanatiling kalusugan sa Silangan, Sentral, at Timog Aprika. Bahagi rin siya ng Women in Global Health – Africa Hub secretariat na naninirahan sa Amref Health Africa, isang Regional Chapter na nagbibigay ng plataporma para sa mga talakayan at isang collaborative space para sa gender-transformative leadership sa loob ng Africa. Si Sarah ay miyembro din ng Universal Health Coverage (UHC) Human Resources para sa Kalusugan (HRH) sub-committee sa Kenya. Mayroon siyang mga degree sa Public Health at isang Executive Masters sa Business Administration (Pandaigdigang Kalusugan, Pamumuno at Pamamahala). Si Sarah ay isang masigasig na tagapagtaguyod para sa pangunahing pangangalaga sa kalusugan at pagkakapantay-pantay ng kasarian sa sub-Saharan Africa.

Irene Alenga

Nangunguna sa Pamamahala ng Kaalaman at Pakikipag-ugnayan sa Komunidad, Advocacy Accelerator

Si Irene ay isang matatag na social economist na may over 13 taon na karanasan sa pananaliksik, pagsusuri ng patakaran, pamamahala ng kaalaman, at pakikipagsosyo sa pakikipagtulungan. Bilang isang mananaliksik, siya ay kasangkot sa koordinasyon at pagpapatupad ng higit 20 mga proyektong pananaliksik sa panlipunang ekonomiya sa iba't ibang disiplina sa loob ng Rehiyon ng Silangang Aprika. Sa kanyang trabaho bilang Knowledge Management Consultant, Si Irene ay kasangkot sa mga pag-aaral na may kaugnayan sa kalusugan sa pamamagitan ng trabaho sa kalusugan ng publiko at mga institusyong nakatuon sa teknolohiya sa Tanzania, Kenya, Uganda at Malawi kung saan siya ay matagumpay na nanunukso ng mga kwento ng epekto at nadagdagan ang visibility ng mga interbensyon ng proyekto. Ang kanyang kadalubhasaan sa pagbuo at pagsuporta sa mga proseso ng pamamahala, mga aral na natutunan, at ang pinakamahuhusay na kagawian ay ipinakita sa tatlong taong pamamahala sa pagbabago ng organisasyon at proseso ng pagsasara ng proyekto ng USAID| DELIVER at Supply Chain Management System (SCMS) 10-taon na proyekto sa Tanzania. Sa umuusbong na kasanayan ng Human Centered Design, Matagumpay na napadali ni Irene ang isang positibong end to end na karanasan sa produkto sa pamamagitan ng pagsasagawa ng mga pag-aaral sa karanasan ng user habang ipinapatupad ang USAID| DREAMS Project sa mga kabataang babae at kabataang babae (Mga AGYW) sa Kenya, Uganda, at Tanzania. Si Irene ay bihasa sa pagpapakilos ng mga mapagkukunan at pamamahala ng donor, lalo na sa USAID, DFID, at EU.

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