Adolescent Friendly Health Services, Uganda
Project Name and Location:
Basic Education, Child Care and Adolescent Development (BECCAD), with a particular focus on Adolescent Friendly Health Services (AFHS) in 5 districts of Uganda: Nebbi; Rukungiri; Kabale; Mbale; and Kiboga.
Background/Rationale for Project:
The 1991 Population census showed that one-quarter of Uganda's total population is between the ages of 10 and 19 years. The effect of the AIDS epidemic in Uganda has been severe. As of 1998, UNAIDS estimates that 930,000 Ugandans are living with HIV infection or AIDS. In adults, the infection rate is estimated to be 9.5%.
It is estimated that 1.8 million Ugandans have already died of AIDS and there may be as many as 1.7 million children who have lost their mothers or both parents to AIDS. USAID estimates considerable increases over time and that 2.7 million children will be orphans by the year 2000. It is notable that at least one child out of four families in Uganda is taken care of by adults who are not the child's biological parents (DHS 95). It is estimated that 7.3% of reported AIDS cases are children less than 12 years (ACP Surveillance report March 1999).
It is also reported that AIDS is responsible for 12% of annual deaths in Uganda and has surpassed malaria and other diseases as the leading cause of deaths among individuals 15-49 years of age. Approximately 26% or 43,000 babies are infected through mother to child transmission of HIV every year and two thirds of those do not live to see their second birthdays.
However, there is reason for hope. Recent data indicate a significant declining trend in HIV seroprevalence (the proportion of the population infected) and incidence (the number of new infections during a certain time period expressed as a proportion of the population at risk). In sentinel site surveillance through antenatal clinics (ANCs), all urban sites showed evidence of significant decline during the first half of the 1990s- as much as 10 to 15 % in some sites. There appears to be a great deal of regional variability in the spread of HIV infections in Uganda. While two major urban areas remained at a median of 14.7 % at the end of 1997, areas outside of urban centres varied from 1.6 % to 14.5 %, with a median of 8.75%. There is evidence that the decline in prevalence is not because of a 'saturation effect', the stage in an epidemic where most of those who might be infected are infected. There are districts in Uganda where HIV prevalence among the sexually active population has remained relatively low and the prevalence in this population has decreased further over time.
It was also reported that Uganda has the third largest teenage pregnancy rate in Africa. The Uganda Demographic and Health Survey (UDHS) 1995 indicates that by 17 years of age, 43.3% of adolescent girls have begun child bearing and by 19 years over 70.8% of adolescent girls have given birth or are pregnant with their first child. Reports from Mulago Hospital show that 20-30% of maternal deaths were due to complications resulting from teenage abortions.
Street children are also a growing phenomenon in Uganda. Currently 10,000 children are estimated to live and work on the streets during the day in urban areas. Child labour is also emerging as a major problem. About 23% of children between 10 and 14 years old are presently working. In Uganda, services for vulnerable children are mainly provided by extended families, communities, CBOs and NGOs. However, the capacities of extended families to cope with the demand are generally acknowledged to have peaked, while district and local councils are yet to fully respond to the need for increased services.
Implementer(s): Reproductive Health Division in the Ministry of Health (MOH) and District Health Management Teams in collaboration with other district staff.
Lead Partner: Reproductive Health Division, MOH
Partner(s)/alliances: Ministry of Gender, Labour and Social Development, WHO, UNFPA, NGOs and private associations
Funding Source(s) and Overall Budget: General resources and supplementary funding from SIDA/Austria. 1999 budget 200,000 USD.
Objectives: Promote the full cognitive and psycho-social development of children and adolescents within a supportive family and community environment which is conducive to education for all, prevention of HIV/AIDS/STIs, adequate care and protection of children and adolescents from birth to adulthood. Programme interventions include:
Beneficiaries/participants: Young people between 10 and 24. No figures available on number and gender reached
Description of Activities:
Adolescent Friendly Health Services:
How have adolescent boys and girls been involved in the project? In what stages have they been involved - situation assessment, situation analysis, planning, implementation, monitoring, and/or evaluation?
Has a formal evaluation been performed? Please elaborate. Not as yet
What were the main constraints in meeting the project objectives?
Lessons Learned/Recommendations/What would you do differently if you could do it over?
What programme support tools/resources were developed that can be used/adapted by other country offices?
Youth Perspective: Not available
Source of information:
Tim Rwambuhemba UNICEF-Kampala