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Innovations vs.

Sustainability: Exploring feasible approaches for sustainable youth friendly ASRH services in resource limited settings
Presented by: Timothy Oboth Plan International Uganda

Session Objective
To explore the feasibility of different approaches for Youth Friendly Services (YFS) for Sexual Reproductive Health (SRH) in resourcelimited communities in northern Uganda

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Poor youth SRH outcomes among in Uganda

Sexual activity among teen girls


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Median age at 1st and marriage

Source: UDHS 2011

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Background: factors

High levels of poverty Limited access to accurate/comprehensive SRHR information/services <35% Negative socio-cultural stereotypes
Aggravate gender inequality Inhibit inter-generational communication on SRHR

Weak public health service delivery system

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Background

Consequences:
High teen pregnancy rate - 24% High school dropout rate primary school completion 25% Longer exposure to SRH risks among teenage girls who are sexually active

Maternal morbidity/mortality among teen mothers is 5 times that of adult women


Failure to attain full socio-economic potential

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Plan Uganda Intervention Objectives

Reduce Y/SRH risks & improve outcomes through comprehensive information services & life skills To compare two models of service delivery
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Model I - Specialized Youth Centers

Set up specialized youth centers (YC) to ensure one-stop access to YFS


Supported districts to deploy dedicated Y/SRH providers at YC

Built capacity of community commodity distributers Transitioned to local government at end of grant

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Model II: Y/SRH integration into local system Setup youth-peer SRH
network

Added multi-media mobilization and education

Built capacity of existing public facilities in YFS and quality improvement Engaged influential adults to create an enabling environment for Y/SRH
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Results
Both models yielded immediate improvements in indicators over baselines:
Monitoring Indicator No of youth reached % increase in SRH awareness % increase in consistent condom use % increase in use of other FP methods % reduction in teenage pregnancy Model-I (YC) 49,422 7.8% 12% 15% 5% Model II (Integration) 42,135 55.2% 21.5% 26% 11.7%

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Results

Model-I service delivery at YC stalled due to lack of public financing after transition
Model-II continued to provide Y/SRH services with youth peer leaders integrated into the Village Health Team system

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Challenges

Weak post-conflict public health system Gender-biased socio-cultural practices Unfavorable national Y/SRH/FP policies Civil society weak in advocacy/accountability

Lack of YF spaces for privacy/confidentiality within facilities


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Lessons Learned

Specialized YC are ideal for YFS but:


Unsustainable in resource-poor settings Create dependence

Aggravate stigma for Y/SRH within mainstream health system

Establishing integrated Y/SRH within existing local & district health system:
Cost-effective, yields better results and is sustainable
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Recommendations

Donor/development partner support should:


Not promote parallel systems that are costly and do not live beyond the funding

Be responsive to local contexts


Seek to promote strengthening of established local systems to provide integrated services

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Thank you
Mr. Timothy Oboth Plan International Uganda Timothy.Oboth@plan-international.org

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