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Making
health services to youth comprehensive and accessible
Zimbabwe
National Family Planning Council (ZNFPC)
Sithokozile
Simba MSN, BA, RN
February 08, 2002
Developing
appropriate, effective and replicable models of "adolescent-
friendly" reproductive health information and services in a
rural setting in Magunje.
The national
goal of the adolescent sexual and reproductive health programme
is to develop appropriate, accessible, affordable, and acceptable
youth friendly services convenient to all users. To achieve this
goal one of the pilot initiatives includes a community based "adolescent
–friendly" intervention established to improve access to reproductive
health clinical services. The community based pilot project offers
services within a 25km radius. The project aims to create a supportive
attitude toward youth reproductive health services among parents,
influential people, community leaders and service providers, and
contribute towards the availability and accessibility of quality
reproductive health information and services in the project site
to about 50 percent of the youth.
The meaning
of youth friendly reproductive health services to a rural youth community
Findings from a
formative study on adolescent reproductive health needs and suggested
solutions using a qualitative approach (focus-group discussions and
meetings) directed the design and of the youth-friendly initiative.
The adolescent indicated that they lacked appropriate information
and reproductive health services. They suggested solutions that included
the identification of "adolescent-friendly" adults in the
community to provide counselling on issues pertaining to sexual relationships
or sexuality, reproductive health and any other issues pertinent to
adolescents. In addition the youth also alluded to the importance
of involving adults in encouraging parents to discuss sexuality with
their children and approve increased access to reproductive health
services.
The formative
study findings correlate with results of a baseline survey where
386 unmarried youth aged 10-24 from the pilot site were interviewed
(Phiri and Erulkar, 2000). Youth in the survey indicated that they
found contraception not accessible due to disapproval from parents,
elders and service providers. The recognition of the need to develop
a conducive environment with parental and community approval was
critical in the design of appropriate and effective adolescent-friendly
reproductive-health services.
Implementation
Lessons on the Necessary Components in Terms of Content and Service
Delivery Developed for the Youth Friendly Intervention
Implementation
of the intervention project has been guided by two principles. The
need to build
on what is available to develop capacity in the existing infrastructure
to foster sustainability; and the need to ensure young people’s participation
in the design, planning, implementation and evaluation of services
and programmes.
Facilitative
factors in the implementation of the community-based adolescent
friendly intervention have included:
- Ownership of the youth-friendly reproductive health project
by the local authority through resource support and their
involvement has been an integral component in creating a conducive
environment for the adolescent-friendly activities because:
- The youth project has been incorporated in the social services
committee of the local authority. The project committee has
an advisory capacity and links with the community leadership
in responding to service needs of the project.
- The social services committee supports a youth project sub-committee
responsible for co-ordinating the implementation activities
- The technical experts are ex-officio members of the youth
project committee
- The local authority is also responsible for the running
expenses of the community service centre (the multipurpose
centre comprises of a clinic, library, and recreational facilities
for both indoor and outdoor games and sporting activities)
as well the salaries of some of the centre project staff.
- A partnership has been fostered with relevant ministries
on project implementation activities.
- Providers trained with skills and knowledge to manage
youth reproductive health needs:
- All providers were trained in youth-counselling skills.
The courses were tailor made to suit the different levels
of providers at community and health facility level.
- Service provided by many different routes to respond
to identified reproductive-health needs of the youth (training
focus on professional norms of non-judgemental attitude, confidentiality
and empathy):
- Community based adolescent-friendly counsellors to increase
access to information, education and counselling on adolescent
sexual and reproductive health in schools, community service
centre, health facilities and general community.
Adolescents recommended participating project staffs. The
project staff included village community workers, traditional
midwives, youth leaders, an agricultural extension officer,
teachers, environmental health technicians, nurses aides,
librarian and community service centre assistant. Clearly
defined operational roles and policies were developed or different
levels of providers. A clear delineation of population to
be covered by each community-based counsellor was developed.
- Adolescent-friendly clinical service providers able to
respond to the needs to the needs of youth (training focus on
professional norms of non-judgemental attitude, confidentiality
and empathy):
- Adolescent-friendly services offered through a network of
three health facilities to enhance and increase access and
choice of services for adolescents.
- Community-based cadres and clinical health facility based
cadres (for the project these include community-based distributors,
nurses from three health facilities, and a doctor who visits
once a fortnight).
- A basic package of clinical services including contraceptive
counselling and provision of methods, post abortion care,
pregnancy testing, information on STI including HIV, their
prevention, syndromic management and HIV information and referral
to voluntary counselling and testing centre, as well as referral
for violence and abuse.
- Clinical services available at convenient opening times-the
community service centre changed operational times from Monday
to Friday 8am to 4.30pm to Tuesday to Saturday 10am to 6pm.
- A Management of Information system mechanism that
encompasses an effective documentation system for data collection
by providers at health facility and community based level as well
as an effective tracking system using referral coupons.
- Regular meetings and training updates for community based
and clinical service providers at project and national level to
guide implementation.
- Hosting exchange visits and getting feedback from national
and international visitors coming to learn about the experiences
of the pilot project. The site also hosted the President of the
Rockefeller Foundation, Mr Gordon Cornway.
- Regular annual social mobilisation to engender parental
and community support to improve project awareness
- Mid-term review to facilitative consultation on learning
experiences and the development of concise revision in the implementation
of the project
Lessons learnt
The critical strategies
that need to be put in place to scale-up the implementation of the
community-based model are based on feedback from project providers,
youth and community. Counselling training and orientation in adolescent-friendly
services is required for all providers at a health facility. Initially
the project only trained one or two providers per site.
A parent-education
component should from part of any adolescent-friendly service initiative
to bridge the knowledge gap between parents and adolescent. Developing
a linkage of adolescent-friendly sexual and reproductive health
services to basic livelihood (income generation) and life saving
skills is important to ensure that implementation responds to important
adolescent issues.
Building in
strategies to reach more girls is crucial. The project appears to
be reaching more boys than girls. Perhaps the addition of female
youth leaders may facilitate service utilisation by girls.
Provision of
convenient outreach transport such as bicycles to enable community-based
counsellors to perform outreach is beneficial. Initially the plan
was for community –based providers to be approached by adolescents
after training. Currently community-based counsellors are approached
by adolescents and parents and requested to visit adolescents in
their homes.
A policy framework
needs to be in place that can facilitate the implementation of adolescent-friendly
services nation-wide. This pilot project has demonstrated that adolescent-friendly
providers are able to offer services to adolescents who are under
16 years and create parental and community support.
References
Phiri. A. &
Erulkar A.S. (2000). Experiences of Youth in Rural Zimbabwe.
Zimbabwe National Family Planning Council and Population Council,
Nairobi, Kenya.
Zimbabwe National
Family Planning Council. (1997). Developing Effective Reproductive
Health Service Models for Youth in Zimbabwe. Harare, Zimbabwe.
Visit the ZNFPC
fact sheet
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