Why focus must be on youth-friendly health services

Chemba. Having worked as a medic and interacted with the youth for years now, Dr Ndosi Karamaeli knows it just too well that adolescence comes with opportunities as well as risks for the young people.

Actions taken during adolescent age, says Karamaeli, could set the stage for a healthy or unhealthy adulthood, yet it’s not an easy task to influence the youth to take up certain basic health services.

He says, “Young people have their own language and style of communicating their health problems. It is important that they are treated by health personnel who understand them and are trained to handle their needs.”

Who is on it in Tanzania?

Such a reality facing the youth in Tanzania is manifested at 10 health facilities located in Chemba and Misungwi districts, where young people—aged between15 and 24—are being offered youth-friendly health services.

Under a project dubbed: Mkapa Fellows-phase III, which is run by Benjamin Mkapa Foundation (BMF), the youth in the districts are receiving Reproductive Maternal Newborn and Child Health (RMNCH) and HIV/Aids services for Adolescent Girls and Young Women (AGYW).

Despite the availability of such services, some adolescents have always seen no good reason for visiting the health facilities, says Dr Karamaeli as he describes the adolescents—a diverse and somehow complex group.

At times age could be just a number. In Tanzania, a 12-year old boy on the street may be fending for himself. He will grow up differently from another boy—of the same age but growing up under the care of a well-established family.

Tanzania’s National Health Policy 2018(which is still in draft), the Health Sector Strategic Plan (HSSP) 2015 – 2020, and the One Plan II, all recognize adolescents and call out the need to address adolescent health in the country.

Scaling up the programs

BMF, through their Mkapa Fellows phase III implementation of the project over the next 4 years (2018 – 2022), in collaboration with the government are working to scale up programs that will help boost youth-friendly health services.

Dr Karamaeli, who is also the National Facilitator for Youth’s Reproductive Health Services, believes the message about the availability of youth-friendly services can reach the young girls and boys through every medium—on radio, social media and youth gatherings or events where the right message can penetrate to them.

“These days, things have also changed. Youth don’t have to line up for health services at hospital, together with other age-groups. At the facilities we are dealing with, the young people can find sign posts written, “Huduma kwa Vijana zinapatikana hapa,” meaning youth services found here.

The services are now placed separately because—for some cultural reasons—some adolescents believe that if they report to a health facility with certain health problems, they may get in trouble with community members.

Challenges such as Sexually Transmitted Infections (STIs) or unwanted pregnancies may remain unaddressed because the youth fear being scrutinized or reprimanded by the community.

The fear to seek help

When they are faced with common conditions such as fever, respiratory infections, dengue fever or malaria, they may not hesitate to seek healthcare, however, when it comes to more sensitive matters, the opposite is the case.

The fear attached to STIs and pregnancies, makes the youth tackle some of their challenges in clandestine, a situation that may pose danger to life and health.

That’s why they need privacy and good communication between them and healthcare providers because they fear being asked difficult questions or being subjected to procedures that may be unpleasant to them.

But, with the ongoing investment in youth’s health through funding from Irish Aid and local fundraising, BMF seeks to bridge the gap in Chemba and Misungwi Districts through activities that began in June 2018 under the Mkapa Fellows Program Phase III.

Dr Karamaeli, who recently teamed up with other experts, under BMF, is keento assess the progress made towards deployment of the youth-friendly services in Chemba District.

“Through ongoing training on youth-friendly services, we now want to assure ourselves that the targeted people have been impacted positively through the project,’’ says the medic.

He believes much more focus must now be on the young people—especially in behavioral change communication during this period, to save them from various health challenges in the years that lie ahead. According to the current (2016-17) Tanzania HIV Impact Survey (THIS), it is estimated that 1.4 percent (2.1 percent among females and 0.6 percent among males) of 15-24 year olds are living with HIV.

The impact is mostly pronounced among younger adults with women in the 15-19 and 20-24 age-groups , all having prevalence more than double that of males.

In rural parts of the country, where BMF experts have been dealing with youth, lessons have been learnt. There is a pressing need for more focused interventions to avert new infections and reduce viral load among infected Adolescent Young Women and Girls.

A medic at Dodoma Regional Referral Hospital, Dr Veronica Raphael who is also the Acting Coordinator for Reproductive and Child Health, says young girls end up with unwanted pregnancies because they face identity crisis.

“We have seen cases of young girls who don’t really know how to guard themselves from such scenarios because they have not been educated in that aspect,’’ she says.

“When we went out the field, we found out that there are girls who have been forced to undergo Female Genital Mutilation but also ended up with teenage pregnancies,’’ she reveals.

“Such girls face even a greater risk of complications during child birth. The fact that a girl has undergone FGM means that during the process of giving birth, she may experience tears in the walls of the birth canal,’’ she explains.

“In Chemba, where we have been working to serve the youth through supportive supervision under Mkapa Foundation, we encountered a case of a 22-year old pregnant girl whose genitals had been mutilated,” she recalled.

“We assisted her to give birth but she had already experienced what we call second degree tear. Quite often, girls with such challenges end up suffering Post-Partum Hemorrhage and they may die if they are not given the attention,” she says .