Youths (aged 10 – 24years) make up 17% of the global population and 22% of Nigeria’s population. Thus, adolescents constitute a significant proportion of the population and ought not to be ignored by any sector. Sadly, they are often neglected especially with respect to their reproductive health. Adolescents face several challenges that impact on their overall wellbeing. Worldwide, one third of all new HIV cases involve young people aged 15–24years; and globally and in Nigeria, 18% and 20% adolescents respectively are married before the age of 19 years.
Additionally, gender discrimination is evident with 0% males compared to 18% females aged 15-19 years being married or in union. About 21% of females aged 20-24 years also report that they gave birth before 18 years. These data demonstrate adolescents’ poor health status and reiterate the need for preventive and health promotion strategies to improve the situation. One of such strategies is ensuring access to youth friendly health services.
Youth in need of care, especially sexual and reproductive health care may either decline to use available health services or be denied access to them for various reasons: providers may be biased and not feel comfortable serving youths who are sexually active. By contrast, youths may not feel comfortable accessing existing services because service providers are “judgmental” and may not meet their needs. Youth Friendly services have been shown to be a tool in overcoming these barriers.
In recognition of the problems faced by adolescents/youths in Nigeria, the Federal Ministry of Health in 2010 launched the National Action Plan for advancing the health and development of young people in Nigeria. This National Action Plan stipulates the integration of Adolescents and Youth Friendly Health Services into the country’s Primary Health Care system. In line with this Action Plan, a guideline for integration of Adolescent and Youth Friendly Services into Primary Health Care (PHC) services in Nigeria was launched in June 2013.
Although the Action Plan exists, its implementation is still poor hence the Medical Women’s Association of Nigeria, Rivers State branch is proposing to pilot the implementation of the National Action Plan to integrate Adolescent and Youth Friendly Health Services into PHC services in selected communities in hard-to-reach LGAs in Rivers State. The Primary Health Care Centres in Rivers State are presently not youth friendly.
MWAN proposes to pilot a project to operationalise the action plan of the Federal Ministry of Health and turn 2 health care centres in Andoni LGA into Youth friendly centres and in collaboration with the State Ministry of Health and the Rivers State Primary Health Care Management Board, to eventually scale up this intervention to other parts of the State. Andoni LGA with an estimated population of 248,532 is located in mostly riverine area not accessible by road on account of marshy terrain, with narrow unnavigable creeks surrounded by thick untamed forest and the ocean; the primary occupation is fishing.
Adolescents in Andoni LGA are presently deprived and marginalized. ATABA is located in Ward 10 in Ataba Town in Andoni LGA while UNYEADA is located in Unyeada Town in Andoni LGA. MWAN, Rivers state branch proposes to increase the access of adolescents in Ataba and Unyeada to youth friendly health facilities in this pilot initiative and to eventually scale up the initiative to every primary health facility in Rivers State.
The Major Project Activities against each Specific Objective are itemized below:
Specific Objective 1:
To reposition PHC Facilities MWAN will implement this objective by carrying out these activities
- Conduct rapid appraisal of the selected Primary health care facilities through needs assessment & gap analysis to ascertain their status of youth friendliness
- Undertake advocacy activities to the LGA to inform them about the project and engender community ownership of the project
- Undertake PHC facility preparation and modifications for youth friendly service delivery
- Undertake training of trainers (ToT) and capacity building for staff of the selected PHCs for the delivery of Youth friendly services
- Provide full complement of minimum package of care for youth friendly service delivery as contained in the National Action Plan and National Guideline developed by PPFA and NPHCDA
Specific Objective 2:
To mobilize youths to use the repositioned PHCs. MWAN Project team would carry out the under listed activities:
- Conduct advocacy activities to key stakeholders in these communities to engender buy-in and community ownership
- Carry out baseline survey (quantitative and qualitative) on knowledge and attitude of young people towards youth friendly health services
- Publicly launch the Adolescent Youth Friendly Health Services in PHCs in target communities with focus on information giving to adolescents
- Produce and distribute relevant Information, Education and Behavioural Change Communication materials based on survey findings
- Carry out mass campaigns for increased uptake of services using school and community outreaches, social and mass media, mobile phone campaigns and other community mobilization services like peer to peer education and youth clubs
Specific Objective 3:
To evaluate the effect of these services in improving knowledge, attitude and utilization rates of reproductive health services among young people in these communities The project team would achieve this objective through:
- Baseline data collection to determine their level of Youth Friendliness and the utilization of PHC services by adolescents for sexual and reproductive health services
- Scheduled and unscheduled supportive supervisory visits to ascertain the status of project implementation
- Routine monitoring of facility utilization rates for the various aspects of service delivery at each PHC with quarterly reports to stakeholders
- End of project evaluation to ascertain perception of young people as to the effectiveness of the intervention in improving utilization of reproductive health services in comparison with baseline data
- Dissemination of findings from the project implementation through reports, stakeholder meetings, presentations and publications
Specific Objective 4:
To leverage political support for subsequent/eventual State-wide scale up This will be done by the project team through the under listed activities:
- Carry out in-depth interviews with policy makers
- Conduct advocacy visits to stakeholders
- Carry out public education using media and meetings.
So far, we have carried out all the project activities:
- Inauguration of the Implementation Team
- Stakeholders’ meeting with RSPHCMB
- Community entry meetings
- Facility Appraisal
- Gap Analysis
- Baseline Survey- Focus Group Discussion component done
- Community Household Survey
- Facility Upgrading for Youth Friendly Services
- Training of Trainers for Youth Friendly Service delivery
FORD DISSEMINATION AND WORLD AIDS DAY
FORD FOUNDATION ATABA