The rights of vulnerable groups such as Women and girls, children, Adolescents and youth, People with Disabilities the elderly among others; should uniquely be guarded and their enjoyment supported by all stakeholders. Part of the ways the health rights of special groups can be supported is through establishment of specialized services at hospitals and health centres across the country. According to the Human Rights Commission report 2013; the vulnerable groups in Uganda include, Women and girls, children, Adolescents and youth, People with Disabilities the elderly among others.
Traditionally in Uganda, adolescents and youth alike are still regarded as children and hence have been exploited in part due to the culture of silence imposed upon them as they lack a way to express their voice in family and community affairs. They are not regarded as adults because they are still under the care of their parents, most do not have property, and decisions are still made for them. Adolescents are seen as needing guidance and protection from their parents, relatives and community members. They are also sometimes seen as unruly and stubborn. Many adolescents are still living with their parents and have little or no power to exercise their sexual and reproductive rights. Adolescent girls are particularly disadvantaged as males are accorded higher value than females.
Adolescence is a period of transition from childhood to adulthood. In Uganda, young people (10–24-year-olds) constitute about 33% of the total population. The World Health Organization defines adolescence as ranging from 11 or 12 through 17 or 18 years of age. Most programs in Uganda however use the age range of 10–24 years to denote the age of adolescence/Youth. Adolescence is characterized by emotional, biological and psychological changes, putting adolescents at risk of sexual abuse and exploitation, early marriage, HIV/AIDS, unwanted pregnancies, unsafe abortion and STIs. The youth population is increasing rapidly therefore decision and policy makers need to steer the protection and well being of this group through policy actions that directly benefit their health needs. Adolescents’ sexual and reproductive health is a national concern for Uganda because the country has a youthful age structure with a broad-based population pyramid characteristic of a developing country. According to the World Health Organization, it is estimated that 24% of young mothers die in child birth in Uganda these make a total contribution of 23% of maternal mortality in Uganda.
L- PMAUG 2020 graph, broad-based population pyramid. R-Enthusiastic youth who turned up for the launch of the youth corners in Kitagata hospital, Sheema District, Western Uganda.
UNHCO and her partners are employing evidence based interventions to improve comprehensive maternal, sexual, reproductive and new-born health services through the rights-based approach among rural communities in Uganda. In January 2016, UNHCO facilitated the introduction of youth corners at Kitagata Hospital, Sheema District, Kiganda health centre IV, Mubende District, Kaseta health centre III, Hoima District and Alau and Atipe health centre II’s in Oyam District. These were each officially launched by the district health Officials in collaboration with UNHCO. Youth from all these communities were invited to the inaugural opening of the Adolescent Youth Friendly Services. They were able to receive free instant HIV and cervical cancer testing, health talks in the area of family planning, prevention of HIV/Aids and unwanted pregnancies, counselling and through their youth corner facilitators received TV sets and DVDs. At the launch of the youth corners UNHCO partnered with “Obulamu” project implementers to distribute several information and Educational communication materials on safe motherhood, condom use, and decision making for family planning to the youth. The youth corners are expected to be setup within the health centres and will be operated by trained health workers in Adolescent and youth services.
L- Youth from Kaseta Health centre witness the handover of TV set and DVD to AYFS in-charge. R-Youth from Kitaga listening to health talks from health workers at the hospital.This was during the launch of the UNHCO youth corners in January 2016.
While attending the youth corners, youth are expected to have access to adolescent and youth friendly information, counselling. The TVs and DVDs will be used to air Films, documentaries and plays that provide Sexual Reproductive Health education in an entertaining manner. The Adolescents within the same community both school going and non-school-going will have access to answers for frequently asked questions by their peers such as: Why do boys and girls have relationships? What good and bad things can there be in relationships? What is a good age for girls and boys to start having relationships? What do you think is the best thing for young people to do about sex and relationships? Is early sex pleasant or very risky? Through the Information and Educational and Behavioral Change Communication materials that are distributed at the youth corners along with the counseling services, the adolescents receive strong, consistent messages from their social environment to make informed decisions; abstain from early sex, stay in school, and avoid the negative consequences of early sex/marriage.
UNHCO is not stopping at only advocacy for the structuring of the Adolescent Youth Friendly Services in form of youth corners at health facilities within the communities in Uganda but is also involved in facilitating the realization of the same through offering technical guidance to community health centres on how to start up and operate the AYFS. Further UNHCO has purchased dozens of television sets and DVDs which will be used to air informative and educational material for the benefit of youth within the facility. UNHCO intends to increase access and utilisation of Reproductive health services for the youth in Ugandan communities. According to Moses Kirigwajjo a Program Officer and Community Mobiliser, “the youth corners will enable youth to access specialised services designed for their needs and interests, they will be able to meet as youth to share with and learn from each other concerns within the area of sexual reproductive health.” Kirigwajjo said that the youth corners will be a place for the youth to freely speak up regarding their sexual reproductive rights. If the youth corners are massively instituted and operated across health centres in the country; the number of young mothers dying while giving birth is expected to greatly reduce thereby contributing to the reduction of maternal and new-born morbidity and mortality. In the area of HIV/Aids prevention: The youth corners can be used as a platform for prevention of new infections. Early sexual activity exposes young women and men to HIV/Aids and other diseases such as syphilis and gonorrhea, which in turn make them more vulnerable to HIV. Therefore a major activity the health facility will be able to conduct HIV testing at the youth corners and offer advice on Behavioral change to the youth as well as distribute condoms and contraceptives to youth desiring to avoid pregnancy.
The Youth Corner approach has been used by other organizations in Uganda but with little success as Bright Businge from Kiganda said during the launch of the youth corner; “Last time one organization brought us a pool table and drums but we lacked guidance. This time we are glad you have brought us educational things too.” While addressing fellow youth at Kitagata hospital, Hellen Kajumba the focal point health worker said; “I am of your age and we shall deal with our challenges together. Nobody should intimidate us here at the hospital, the condoms and testing kits are available in the store, you come every Saturday and we boost our youth day clinic.” The Naguru Teenage Information Centre (NTIC) has applied the youth corner approach for decades and has registered success but within a few communities within Kampala. UNHCOs’ successes have been from its strengths that is, community youth driven under the assistance of knowledgeable and committed focal persons and well selected and hardworking VHTs, good relationships with health workers, trusted by community members and available ready support from the community leaders. In Kiganda UNHCO designed adolescent reproductive health awareness campaigns in each and every village. So far 3 camps have been held delving on their youth affairs and community interventions. These were supported by the woman member of parliament.
During the launch of the youth corners in Kabwoya, the Chairman Kabwooya sub county Hoima District decried the increased number of school dropouts in the communities due to early sexual intercourse among the youth. He said; “UNHCO has now supported us let us come and utilize the services. This is your facility and the in charge will allocate a young health worker who understands the youth problems to guide this and also promote integrated youth outreaches to cover all the areas. We are hearing this for the first time and is a landmark for this project.”
UNHCO together with the eight Maternal Health Project Implementing Partners recognize that a variety of issues must be prioritised, tabled, discussed and addressed in order to improve Reproductive Health Rights in the country. First, the legalisation of Health Rights in Uganda must be prioritized through inclusion of the “Right to Health” in the current constitution (http://unhco.or.ug/wp-content/uploads/2014/12/2015-Right-to-Health-Amemndment-Proposed.jpg.