Innovations vs.

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


Promising Futures,
Community by Community
Session Objective



To explore the feasibility of
different approaches for
Youth Friendly Services (YFS)
for Sexual Reproductive
Health (SRH) in resource-
limited communities in
northern Uganda

Promising Futures,
Community by Community
Poor youth SRH outcomes among in Uganda
Sexual activity among teen girls Median age at 1
st
and marriage
7/25/2014 Source: UDHS 2011 3
Promising Futures,
Community by Community
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
Promising Futures,
Community by Community
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
Background
Promising Futures,
Community by Community
Plan Uganda Intervention Objectives
Reduce Y/SRH risks
& improve outcomes
through
comprehensive
information services
& life skills

To compare two
models of service
delivery

Promising Futures,
Community by Community
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


Model I - Specialized Youth Centers
Promising Futures,
Community by Community


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



Model II: Y/SRH integration into local
system
7/25/2014 8
Promising Futures,
Community by Community
Both models yielded immediate improvements
in indicators over baselines:

Results
7/25/2014 9
Monitoring Indicator Model-I (YC) Model II
(Integration)
No of youth reached 49,422 42,135
% increase in SRH awareness 7.8% 55.2%
% increase in consistent condom use 12% 21.5%
% increase in use of other FP methods 15% 26%
% reduction in teenage pregnancy 5% 11.7%
Promising Futures,
Community by Community
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
Promising Futures,
Community by Community
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

Challenges
Promising Futures,
Community by Community
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


Lessons Learned
Promising Futures,
Community by Community
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
Recommendations
Promising Futures,
Community by Community
Thank you
Mr. Timothy Oboth
Plan International Uganda
Timothy.Oboth@plan-international.org
7/25/2014 14