For the longest of time, fear and embarrassment served as a barrier for the 21-year-old young lady, JR, to access reproductive health-care from a dispensary neighbouring her ward in Kimbiji.
“You know it’s difficult for our community to understand that we as adolescents need this service [reproductive and sexual health care] or at least be able to get the basic education to enable us live a healthier life.
It is very difficult to live an adolescents’ life in this challenging world without the right reproductive and sexual care,” the young resident of Temeke expressed her concerns.
Understanding the needs of JR and other young adolescents for reproductive health services and its associated challenges, Mari Stopes, a non-government organisation helping women to have children by choice and not chance, initiated an outreach program catering to adolescents like JR and women.
The initiative brings reproductive health services mainly family planning and sexuality education close to the needy community to one’s door by the use of a three wheeler, popularly known as the ‘bajaj’, accompanied by a driver and a nurse.
“I am so glad that the well-wishers have heard my secret prayer that I have had for so long. I used to find it so difficult to seek reproductive health care from our dispensary worrying what our neighbours or someone might think of me and report it to my parents,” JR rested her case.
Why then the three-wheeler?
Bajaj is becoming the growing mode of transportation in most of the towns and cities in Tanzania.
Until the year 2010, Dar es Salaam had no room for the Indian bajaj or a tricycle to be used as a means of commute.
But as the need for transport became increasingly a concern, bajaj have become famous for transportation and in some places the sole transportation means.
Tanzania is a country with a young and rapidly growing population. Most Tanzanians live in rural areas where health services accessibility has been an issue, however, majority of people who live in towns do so in peripherals creating a remoteness of its kind.
It should be understood that confidentiality, comfortability and privacy is key and essential for reproductive health services promotion and success.
Based on our cultural experiences, sexuality is private and people would not want anybody to know choices one makes in sexuality hence one would not go for family planning in a facility where he/ she thinks will be seen by people who know him/ her.
This makes lots to shy away from visiting health facilities to seek for family planning and other reproductive health services.
For example, women who wish to space or limit their pregnancy but unable to do so because of fear that they will be misinterpreted by the community. Or adolescents who would want to understand their sexuality and safe sex health practices and are unable to because they think of how community will judge them and how much scrutiny they might receive.
Hence bajaj as means of health care delivery (mobile service) has been used in different developing countries, including Tanzania, to provide services and has been proven to be successful in reaching communities in remote areas with services.
How does it really work?
‘Bajaj outreach’ is one of Marie Stopes Tanzania’s most powerful and effective way of reaching people in need of contraception.
Remote and rural health facilities are limited to one type of family planning methods but the bajaj nurse offers a wide range of contraceptive methods.
The organisation has been able to reach more adolescents and women in need through this innovative means and becomes the sole methodology of service delivery in Zanzibar.
The greatest concern of this modality is the quality of services. The bajaj service team is composed of one trained and competent nurse and a driver.
The Nurses are trained in providing reproductive health services and information and are well trained on emergency management for safety of the patients or seekers.
Some of the bajajs’ serve cervical cancer screening services, one of the leading reproductive cancers in the country.
Mary August is one of the nurses serving cervical cancer screening in Dar es salaam. She tells that women are very happy when they see her. “I use the public facility to provide my services and most of the time the number of women come beyond my capacity to handle for the day hence I give appointments.”
Adolescents on the other hand always see no good reason for visiting health facilities.
Adolescents who fall ill with common conditions such as fever, respiratory infections, malaria and et cetera, may have no hesitation in seeking care. However, they may be less willing to do so for more sensitive matters.
Unmarried adolescents fear the burden of scrutiny when they are faced by sexual health problems such as unwanted pregnancy.
Adolescents would wish to understand about safe sex and other means to protect from living a risky life, however, they are unable to face health facilities for they fear being perceived wrongly and worry that their confidentiality and privacy would be in jeopardy.
With increasing daily life demands, people in these towns are very busy hence consider reproductive health services a luxury and consider visiting health services time-consuming.
But it’s promising to see innovative thinking coming in together to achieve the health sustainable development goals and welfare of the Tanzanians.
The author is a researcher on reproductive health at Marie Stopes clinic in Dar es Salaam.