Addressing Neglected Health Issues Among Vulnerable Young People in Africa

byPurity KiguathaProject Officer

AAYMCA

Presentation Outline

• Who we are

• Multi-country health research • Background of the research • Problem statement

• Research objectives

• Research methodology

• Key findings

• Conclusion and recommendationsACT2LIVE

Who we are Africa Alliance of YMCAs (AAYMCA) is the umbrella body

for Young Men’s Christian Associations (YMCAs) in Africa.

AAYMCA has a membership of YMCAs in 20 countries, 16 of which are very active.

Our mission: Empower young people for the African Renaissance

Our Change Philosophy, “From Subject to Citizen” (S2C) works to move young people to become citizens – where they understand the root causes of problems and articulate informed views and are part of positive change at various levels of leadership

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Who we are: Our presence in Africa

Research on neglected health issues affecting vulnerable young people in Africa

• In 2012 YMCAs in six sub-Saharan Africa countries conducted research on neglected health issues for vulnerable young people in Africa

• Overall goal of the research was to better understand health issues among the primary constituent of YMCAs work (adolescents and young adults) to design appropriate and responsive interventions

• Young people were empowered to serve as research assistants to build their attitudes and skills for themselves and later engagement in driving change in the issues identified in the research

Background • According to WHO Neglected health issues are diseases that

affect almost exclusively poor and powerless people living in rural parts of low income countries.

• Our broadened definition of neglected youth health issues; Those diseases and issues that affect vulnerable youth living in low income and rural parts of Africa’s countries

• The research was conducted by the YMCAs in Madagascar, Zambia, Zimbabwe, Liberia, Togo, Senegal and the YWCA in Zambia.

• The research targeted young people aged 15-25 years, youth serving Government and Non-Governmental agencies

Vulnerable Youth

Commercial sex workers Survivors of political violence

Youth living in the street Young people in conflict with the law (including ex-offenders)

Youth living with/affected by HIV/AIDS

Young people affected by conflicts and violence (including ex-combatants)

Youth with disability Young people living in slums

Orphans

Problem statement

• Overall youth populations continue to experience disadvantages in relation to their health, education, employment status and representation in local and national decision making.

• Social stigma towards young people and poor treatment from adults and healthcare workers are major obstacles to provision of care.  

• Underinvestment in health infrastructure, poor governance and mismanagement has led to inadequate health care provisions on many levels.

Research objectives

(a) To understand the status of ‘neglected’ health issues disproportionately affecting young people, including vulnerable and ‘hard to reach’ groups;

(b) To understand the status of youth friendly health care service provision for specific target groups identified in each country.

Methodology

• Structured questionnaires administered to 2,625 young men and women

• Focused group discussion

• Key informant interviews held with government agencies and youth serving organisations

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Key findings

1. There are diseases that young people consider as neglected based on their ability to access information and services. Sexual and Reproductive Health issues were key among these diseases.

2. Access to services for young people is impacted by structural, financial and cognitive barriers

3. While Governments have made commitments at National and Regional level, there is still a large unmet need for health services especially youth friendly services

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Neglected Health Issues

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Sexual health

Mental health

Drug & alcohol abuse

Access to health services

Fistula

Lifestyle illnesses

0 1 2 3 4 5 6 7

Sexual and Reproductive Health

Youth in Zambia (75%) and Zimbabwe (64%) Madagascar (53.79%) identified STI/STDs as top among neglected health issues.

In Togo HIV/AIDS, STI/STDs and Teenage Pregnancy were ranked the top three issues that resulted in stigma for young people.

In Liberia 55% and 36% female and male respondents respectively identified fistula as a health concern that also generated a lot of stigma and discrimination.

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Access to youth friendly services • At least 75% of respondents in Liberia felt that health

workers lack the skills to respond to the needs of young people.

• Health service providers and young people regard each other with a lot of mistrust reducing the uptake of available health services and information

• In many cases young people were generally not aware of the services available at the local clinic or hospital – not feel confident enough to seek out health professionals

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Female respondent from Zambia

FGD participant in Madagascar

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“ As young people we find it difficult to collect contraceptives from clinics because most of the people who work at the health centers are adults who are age mates of our parents … so we fear that they may inform our parents that we are getting contraceptives”

“…female health workers ring insults at young female patients problems openly and even laugh about them with their colleagues…”

Barriers to access to services

Structural barriers: Distance, personnel, medicines and equipment

• Fiscal difficulties in African countries have forced governments to cut back on important health priorities including preventive health and capital investment

• In Zambia only urban and peri-Urban communities are

well served by health centres. Of the 59.7% youth who had visited health facilities only 1.7% felt that the services offered were good

• In Senegal, respondents felt that outdated technical equipment compromise the quality of care young people can access. Facilities were also found to be difficult to access for people with disabilities

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Country 2013/2014

2012/2013

2011/2012

2010/2011

Kenya  

4.2 3.0 8.0 5. 54

Zambia  

6.2 6.8 9.3 9.3

Zimbabwe  

8.2 9.87 - -

Madagascar  

7.5 7.6 8.2 9.2

Togo  

5.5 6 4 4

Senegal  

4.65 4.89 4.73 4.61

Status of health financing

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Health Policy Making

Africa Youth Charter (2006)

Maputo Protocol (2007)

National youth policies Liberia National Youth Policy (2012-2017) Zambia Health Strategic Plan (2011-2015)Zimbabwe National Youth Policy (2000)Togo Youth Policy (2007)

National Health Sector Strategies and Plans

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Financial barriers: ability to pay for services

• In Togo, the cost of services was ranked third among the reasons why young people prefer not to go to the health center for treatment

• In Madagascar 66.4% female and 55.6 male of male respondents cited lack of financial means as the top reason why they do not visit the health center.

• Fiscal difficulties have resulted in cost sharing between government and their citizens putting high costs on services

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Cognitive barriers: Beliefs and knowledge, communication in the patient provider encounter and culture

• Young people are not secure when they visit health centers because of how they are treated by both health workers and adult patients

• At least 75% of respondents in Liberia felt that health workers lack the skills to respond to the needs of young people.

• Youth have been left out in health sector planning and therefore they do not know about the health policies

Promoting youth friendly services: Includes having young people spending time supporting activities at the health facility

Our response

Youth civic empowerment: Giving young people skills and a voice for engagement in health sector dialogue

Youth led advocacy; Creating spaces and opportunities for young people to engage with authorities and decision makers

Capacity building of health service providers in youth friendly service provision

In Madagascar & Liberia: Mobilsing young people, stakeholders in implementation of the programmes

In Zambia: Distribution of condoms during project events

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Partnerships and networking

Conclusion and recommendations

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Youth Engagement:

Young people are interested in being part of the solution in the health sector and can be engaged at high levels of planning and decision making.

Empower young people and create spaces for youth engagement in health sector dialogue and planning

Government commitment to health: Governments need to honor and be held accountable for commitments made at international and local level for improvement of health these include:• Increasing the allocation to health sector to at least 15% -

Abuja Declaration 2011 • Train health service providers youth friendly health service

provision and increasing the number of operational youth friendly health centers –Maputo protocol

• Making health services affordable for example through promotion of health micro insurance or group saving schemes

Conclusion and recommendations contd.

Partnerships:

Strong and long-term partnerships are needed between state and non-state actors to address the needs of young people especially those who are vulnerable and hard to reach

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Conclusion and recommendations contd.