Establishment of adolescent-friendly health centres foster provision of services to young people in Uganda

In Uganda, six regional referral hospitals (RRHs)—Gulu, Jinja, Kabale, Lira, Mbale and Moroto—have begun providing services specifically for young people at the newly-established centres for adolescent-friendly health services (AFHS). This initiative started because often adolescents do not access reproductive health services due to fear of embarrassment and lack of confidentiality at general out-patient units where services are typically initiated. By doing this, Uganda is on the right track toward Goal 3 of the Sustainable Development Goals: Ensure healthy lives and promote well-being for all at all ages.

Adolescents access HTC services at Gulu RRH’s established AFHS centre,. Photo Credit; @URC 2016 USAID/SUSTAIN/Twaha Rwegyema 

Efforts to establish AFHS centres were initiated and supported by the USAID/Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN) project working with the Uganda Ministry of Health and selected hospitals. A series of activities were conducted between October and December 2015, including: a baseline assessment, training of selected healthcare workers and a central collaborative learning session on provision of AFHS which formed the foundation for the take-off of adolescent services.

Between 20 December 2015 and mid-January 2016, a total of 1052 adolescents have accessed medical and reproductive health services at the six newly-established AFHS centres in the different regions.

USAID/SUSTAIN and MOH team meet with the AFHS committee members at Kabale RRH's new AFHS centre; Photo Credit; @URC 2016 USAID/SUSTAIN/ Julian Natukunda 

Together with the MOH teams, the project visited the six health facilities in January 2016 (two weeks after AFHS centres had been established) to support the implementation process. All the hospitals had started offering services and a number of interventions were cross-cutting with the newly-established adolescent centres. These included:

-          All healthcare workers had been sensitized on AFHS, i.e. to offer specific services to the adolescents either at the various entry points or refer them to the adolescent centres; 

-          At least three staff were allocated to run the adolescent centres, including peer educators, a nurse and a counselor:

-          Hospital administration and top management teams were actively involved in the establishment and provision of AFHS;

-          Girls aged 10 years attending AFHS were being offered HPV vaccination upon sensitization;

-          All hospitals had trained and deployed at least one adolescent peer to support AFHS delivery; and

-          Ongoing sensitization occurred for patients in the different departments about the specialized services for adolescents to increase demand.

“I have attended the first session of health education and appreciated the message delivered especially on growth and development, hygiene, and sexual issues, which I find complex for me to explain to my children,” said Francis. He was one of the parents who, upon escorting their child to the centre, attended a health education session on AFHS at the outpatients department at Kabale RRH.

Out of six hospitals (excluding Jinja RRH), five hospitals identified at least one free room where adolescent-friendly services were offered. The AFHS package at these centres includes HIV testing and counseling, psychosocial assessment, clinical and nutrition assessment, health education on growth and development, sexual reproductive health issues and family planning. For specialized services, adolescents are referred and physically escorted to the specific units. The hospitals pledged to support provision of services to adolescents on Saturdays to serve those who spend their time at school during the week.

To streamline delivery, the project and MOH teams further supported AFHS committees to develop client flow charts and duty rosters as well as to discuss various mobilization activities that would attract more adolescent to the centres. The project team also delivered the first batch of recreation materials—such as Ludo and chess—and plan to equip the centres with chairs, tables, height boards and television sets to create an ideal environment for adolescents.

The success in establishing AFHS centres is attributed to the active involvement of hospital administrative and management members in the design and implementation process. In addition, the formation of AFHS-specific committees and the positive attitude of healthcare workers provided an effective platform for the provision of AFHS. After one year, lessons learned from the six model centres will be used to establish similar services at the remaining public healthcare facilities in the country.

 

Written by Julian Natukunda, Communications Specialist, USAID/SUSTAIN Project