Rita Murungi, 26, works in one of the busiest bars in Mbarara, in southwestern Uganda. She is among the youth (generally categorized by the UN as young people between the age of 15 and 24, with slightly higher upper age limits provided in other definitions) who visit the Youth Center at Reproductive Health Uganda’s (RHU) Mbarara Clinic for recreational activities.
Although the clinic and the youth center are in the same vicinity, young people rarely visit the clinic for health services. The youth center’s main purpose is to attract young people to access Sexual and Reproductive Health (SRH) services — yet this goal has been largely unaccomplished in Mbarara.
“The youth used to come [to RHU] for only recreation activities, and they would go without accessing services,” Chris Abaho, a volunteer with RHU explained.
He adds: “For instance, Rita knew that services were offered at RHU, but she was afraid to approach people [RHU health workers].”
Oftentimes, one factor preventing young people from seeking out SRH services is embarrassment and social stigma. As a result, many youth in the community do not seek out these services, challenging RHU to come up with innovative ways to attract young people to the clinic.
In March 2014, a team from the International Planned Parenthood Federation (IPPF) Africa Regional Office (ARO) and Management Science for Health (MSH) trained an RHU senior management team as Trainer of Trainers (ToTs) in the LDP+ program. The LDP+ is a participatory leadership program that enables teams to face challenges and achieve results through a process called team-based action learning.
In May of the same year, the ToTs trained at least five staff members from each of the five RHU branches across Uganda selected to pilot the LDP+. Mbarara was among these five.
The Obstacle: After the step-down training in the Mbarara clinic, the team identified their clinic’s low client load, especially among young people, as their biggest organizational challenge.
Abaho, an RHU Mbarara staff member, noted that: “We identified the lack of linkages between the youth center, the community, and the clinic as the challenge. There was no synergy between these. These were working separately. The youth would come to the youth center to access recreational activities, but would not come to the clinic for SRH services.”
The Solutions. The team agreed that the clinic and the youth center needed to complement each other and work together to achieve greater SRH service utilization. There was strong a need to develop innovative ways to attract the young people who visited the youth center to also utilize SRH services at the clinic, and to mobilize their peers to do the same.
The RHU Mbarara team agreed that in order to achieve their goals, they would need to improve their own performance to help them to better suit their clients’ needs. To this end, they rescheduled weekly staff meetings from Monday to every Friday afternoon, after finding that “Monday meetings were affecting the clients. Usually there are more clients on Monday and most of them come in the morning. Therefore we shifted the meetings to Friday afternoons when the clients are few and can be handled by one service provider” Abaho said.
Similarly, after the LDP+ training, the RHU Mbarara team also decided to include community stakeholders, such as young people, in their weekly meetings. This was a new step for them, as before only staff and a few volunteers were invited.
In these meetings, they reviewed plans from the previous week and planned for the new week ahead. “We began to plan jointly for both the youth center and the clinic at the same time. We would now collaborate with each other, unlike before where each would plan independently. Surely this has improved our branch team work,” Abaho noted.
Another strategy implemented was the initiation of monthly health education talks at the youth center facilitated by the clinic’s health workers. Now, RHU Mbarara health workers could provide some services at the youth center, rather than waiting for them at the clinic. The team initiated a special day for SRH provision at the youth center, including HIV testing and counselling, provision of contraceptives, and other general SRH services.
It was through such initiatives that Rita Murungi began receiving timely help and support. “I went to the nurse and requested to talk to her; I told her about my situation and she invited me to the clinic where I was able to get treatment,” she said.
She added, “It’s not that I didn’t know where to go for services, but I was scared of whom to talk to and how to explain everything. [After going the first time for treatment,] me and my boyfriend tested for HIV together for the first time. (We) are now okay with no worries, because I am using a three-month injection for family planning to avoid unwanted pregnancies.”
All of these actions ultimately led to an increase in the number of youth coming to RHU Mbarara for SRH services, from an average of 39 youths between January to May 2014, to a monthly average of 136 youths between June and November.
”This has not only improved youth participation in addressing their own needs, but also contributed to the client load for the clinic because many now freely visit the clinic for services,” says Donanta Muhereza RHU clinic service provider.