1. Addressing Neglected Health Issues Among Vulnerable Young People in Africa by Purity Kiguatha Project Officer AAYMCA

2. Presentation Outline Who we are Multi-country health research Background of the research Problem statement Research objectives Research methodology Key findings Conclusion and recommendations ACT2LIVE

3. Who we are Africa Alliance of YMCAs (AAYMCA) is the umbrella body for Young Men’s Christian Associations (YMCAs) in Africa. AAYMCA has a membership of YMCAs in 20 countries, 16 of which are very active. Our mission: Empower young people for the African Renaissance Our Change Philosophy, “From Subject to Citizen” (S2C) works to move young people to become citizens – where they understand the root causes of problems and articulate informed views and are part of positive change at various levels of leadership

4. PRESENTATION NAME Who we are: Our presence in Africa

5. R esearch on neglected health issues affecting vulnerable young people in Africa In 2012 YMCAs in six sub-Saharan Africa countries conducted research on neglected health issues for vulnerable young people in Africa Overall goal of the research was to better understand health issues among the primary constituent of YMCAs work (adolescents and young adults) to design appropriate and responsive interventions Young people were empowered to serve as research assistants to build their attitudes and skills for themselves and later engagement in driving change in the issues identified in the research

6. Background According to WHO Neglected health issues are diseases that affect almost exclusively poor and powerless people living in rural parts of low income countries. Our broadened definition of neglected youth health issues; Those diseases and issues that affect vulnerable youth living in low income and rural parts of Africa’s countries The research was conducted by the YMCAs in Madagascar, Zambia, Zimbabwe, Liberia, Togo, Senegal and the YWCA in Zambia. The research targeted young people aged 15-25 years, youth serving Government and Non-Governmental agencies

7. Vulnerable Youth Commercial sex workersSurvivors of political violence Youth living in the streetYoung people in conflict with the law (including ex-offenders) Youth living with/affected by HIV/AIDS Young people affected by conflicts and violence (including ex-combatants) Youth with disabilityYoung people living in slums Orphans

8. Problem statement Overall youth populations continue to experience disadvantages in relation to their health, education, employment status and representation in local and national decision making. Social stigma towards young people and poor treatment from adults and healthcare workers are major obstacles to provision of care. Underinvestment in health infrastructure, poor governance and mismanagement has led to inadequate health care provisions on many levels.

9. Research objectives (a)To understand the status of ‘neglected’ health issues disproportionately affecting young people, including vulnerable and ‘hard to reach’ groups; (b)To understand the status of youth friendly health care service provision for specific target groups identified in each country.

10. Methodology Structured questionnaires administered to 2,625 young men and women Focused group discussion Key informant interviews held with government agencies and youth serving organisations ACT2LIVE

11. Key findings 1.There are diseases that young people consider as neglected based on their ability to access information and services. Sexual and Reproductive Health issues were key among these diseases. 2.Access to services for young people is impacted by structural, financial and cognitive barriers 3.While Governments have made commitments at National and Regional level, there is still a large unmet need for health services especially youth friendly services ACT2LIVE

12. Neglected Health Issues ACT2LIVE

13. Sexual and Reproductive Health Youth in Zambia (75%) and Zimbabwe (64%) Madagascar (53.79%) identified STI/STDs as top among neglected health issues. In Togo HIV/AIDS, STI/STDs and Teenage Pregnancy were ranked the top three issues that resulted in stigma for young people. In Liberia 55% and 36% female and male respondents respectively identified fistula as a health concern that also generated a lot of stigma and discrimination. ACT2LIVE

14. Access to youth friendly services At least 75% of respondents in Liberia felt that health workers lack the skills to respond to the needs of young people. Health service providers and young people regard each other with a lot of mistrust reducing the uptake of available health services and information In many cases young people were generally not aware of the services available at the local clinic or hospital – not feel confident enough to seek out health professionals ACT2LIVE

15. Female respondent from Zambia FGD participant in Madagascar PRESENTATION NAME “ As young people we find it difficult to collect contraceptives from clinics because most of the people who work at the health centers are adults who are age mates of our parents … so we fear that they may inform our parents that we are getting contraceptives” “…female health workers ring insults at young female patients problems openly and even laugh about them with their colleagues…”

16. Barriers to access to services Barriers to access to services Structural barriers: Distance, personnel, medicines and equipment Fiscal difficulties in African countries have forced governments to cut back on important health priorities including preventive health and capital investment In Zambia only urban and peri-Urban communities are well served by health centres. Of the 59.7% youth who had visited health facilities only 1.7% felt that the services offered were good In Senegal, respondents felt that outdated technical equipment compromise the quality of care young people can access. Facilities were also found to be difficult to access for people with disabilities PRESENTATION NAME

17. ACT2LIVE Country2013/20142012/20132011/20122010/2011 Kenya 4.23.08.05. 54 Zambia 6.26.89.3 Zimbabwe 8.29.87-- Madagascar 7.57.68.29.2 Togo 5.5644 Senegal 4.654.894.734.61 Status of health financing

18. ACT2LIVE Health Policy Making Africa Youth Charter (2006) Maputo Protocol (2007) National youth policies Liberia National Youth Policy (2012-2017) Zambia Health Strategic Plan (2011-2015) Zimbabwe National Youth Policy (2000) Togo Youth Policy (2007) National Health Sector Strategies and Plans

19. PRESENTATION NAME Financial barriers: ability to pay for services In Togo, the cost of services was ranked third among the reasons why young people prefer not to go to the health center for treatment In Madagascar 66.4% female and 55.6 male of male respondents cited lack of financial means as the top reason why they do not visit the health center. Fiscal difficulties have resulted in cost sharing between government and their citizens putting high costs on services

20. PRESENTATION NAME Cognitive barriers: Beliefs and knowledge, communication in the patient provider encounter and culture Young people are not secure when they visit health centers because of how they are treated by both health workers and adult patients At least 75% of respondents in Liberia felt that health workers lack the skills to respond to the needs of young people. Youth have been left out in health sector planning and therefore they do not know about the health policies

21. Promoting youth friendly services: Includes having young people spending time supporting activities at the health facility Our response

22. Youth civic empowerment: Giving young people skills and a voice for engagement in health sector dialogue

23. Youth led advocacy; Creating spaces and opportunities for young people to engage with authorities and decision makers

24. Capacity building of health service providers in youth friendly service provision

25. In Madagascar & Liberia: Mobilsing young people, stakeholders in implementation of the programmes In Zambia: Distribution of condoms during project events ACT2LIVE Partnerships and networking

26. Conclusion and recommendations ACT2LIVE Youth Engagement: Young people are interested in being part of the solution in the health sector and can be engaged at high levels of planning and decision making. Empower young people and create spaces for youth engagement in health sector dialogue and planning

27. Government commitment to health: Governments need to honor and be held accountable for commitments made at international and local level for improvement of health these include: Increasing the allocation to health sector to at least 15% - Abuja Declaration 2011 Train health service providers youth friendly health service provision and increasing the number of operational youth friendly health centers –Maputo protocol Making health services affordable for example through promotion of health micro insurance or group saving schemes Conclusion and recommendations contd.

28. Partnerships: Strong and long-term partnerships are needed between state and non- state actors to address the needs of young people especially those who are vulnerable and hard to reach ACT2LIVE Conclusion and recommendations contd.