Inside Jupanziri Health Centre III
The haven for adolescents in Nebbi District
Inside the delivery suite of Jupanziri Health Centre III in Nebbi district, 18-year-old Patricia Airwoth paces in agony, taking brief pauses to rub her lower back and rest on the delivery bed.
‘Do not lie on your stomach, it is not good for the baby’, the midwife instructs. In the adjacent labour ward, five other girls await their turn.
At Jupanziri in northern Uganda, nearly half of the deliveries in 2018 were mothers aged 10-19 years. Teenage pregnancy was a major sexual and reproductive health concern, with the related effects of maternal and child mortality, increased HIV infections and early school drop outs. The area around the health centre had also become a hotspot for drug abuse, crime and disorderly behavior. However, between January and September 2019, teenage pregnancy dropped to 11.3 per cent, less than the country average of 25 per cent and Jupanziri is a thriving centre for adolescent health and learning activities. What happened?
“We are doing the same things differently”
During a staff meeting in December 2018, the Jupanziri health facility team analyzed the patient records and noted that on the first antenatal visit, one out of every two pregnancies were girls under 19 years. The demographics further revealed irregular antenatal visits, and when the children were born, frequent cases of malnutrition and a host of health issues.
“When UNICEF offered quality improvement capacity building, we paid attention, acted, and then results started flowing in,”
Advocacy and mobilization of adolescents
Adolescent-targeted activities take place at the health centre every day. Mondays are designated ante-natal days for adolescents only. Every Tuesday, an adolescent group formed in February 2019 meets to receive exclusive health education and peer counselling as well as conceptualize drama shows for community outreaches. Though adolescents are considered to be within the age group 10-19, others above this age bracket have joined the group and become champions for responsible living and adolescent health. On other evenings, the adolescents convene to play football, volleyball and netball. Jupanziri Adolescent Group also started at savings and credit group to improve their economic well-being. Through weekly savings of UGX 500 per member, the 84-person group has accumulated a cash balance of UGX 803,700. The group, which is governed by a constitution, also has started a small agricultural project to generate more income. 43 of the members are girls.
The entire village appreciates the change brought about by the adolescent-friendly programming. Erussi sub-county is considering ways of supporting the group through a 30 per cent allocation of development grants towards community driven development. The local council and clan leaders also have developed by-laws to govern pre-disposing factors for teenage pregnancy, highlighting parental roles and responsibilities and addressing social economic activities that detract from education.
“UNICEF provides support, our work is to sustain impact,”
In addition to training health care providers in core aspects of adolescent friendly service provision, UNICEF with financial support from SIDA, also refurbished the labour ward, creating a partition for adolescent girls and installed a solar system, eliminating the use of torches during delivery. Plans to motorize a borehole that will bring water to the maternity ward are underway. Though some problematic pregnancy cases are referred to the main hospital, Jupanziri’s midwife Harriet Atimango points out that, ‘They come back to Jupanziri when the labour has already begun. They feel comfortable here’
Dr. Rabbin Drabe, UNICEF’s Programme Specialist notes that UNICEF’s adolescent programming focuses on strengthening the health system to enable delivery of adolescent-friendly services which in turn enhance patient utilization and satisfaction.’ At Jupanziri, this utilization is evident with a rise in mothers reporting for ante-natal care, immunization and family planning services.
Back in the delivery room, Patricia gives birth to a healthy baby boy after 10 hours of labour. It is a normal birth. Five pregnant adolescents in the labour ward giggle sporadically as they chat in their local dialect, waiting for the onset of birth pangs. In the Out-Patient department room, the Jupanziri Adolescent Group members make their daily collection of UGX.500 per person.
With just two months left to go, Jupanziri’s goal of reducing teenage pregnancy from 44 per cent to 10 per cent by December 2019 seems well within reach.
‘Thereafter we will aim at zero per cent teenage pregnancy’, the head of Jupanziri Health Centre concludes.