The extent to which the design of available reproductive health interventions fit the reproductive health needs of adolescents living in urban poor settings of Kisenyi, Kampala, Uganda

Abstract

Background The rate at which informal urban settlements (slums) are developing in Low and Middle Income. Countries (LMICs) like Uganda is high. With this, comes the growing intersection between urbanization and the reproductive health of key populations. Currently, a number of interventions are being implemented to improve the Reproductive Health (RH) of adolescents in Kisenyi, the largest informal urban settlement in Kampala, the capital of Uganda. Despite these efforts, adolescent RH indicators have persistently remained poor in Kisenyi. This could be indicative of a gap between the provided and needed adolescent RH interventions. We assessed the fit between the available interventions and the RH needs of adolescents living in Kisenyi. Methods We conducted a qualitative study in July 2019–February 2020 in Kisenyi. The methodology was guided by the Word Health Organization global standards for quality-health care services for adolescents, the “For whom? Where? By whom? and What?” Framework of sexual RH service delivery and the realist evaluation approach. Eight focus group discussions were conducted with adolescents 15–19 years to explore their RH needs. The design and implementation of the available adolescent RH interventions were assessed by conducting Key Informant interviews with 10 RH service providers in Kisenyi. Validation meetings were held with adolescents and they scored the extent to which the various design features of the existing interventions fit the adolescents’ RH needs. Results The available RH interventions focused on meeting the sexual RH needs like providing family planning services but less on social needs like livelihood and sanitation which the adolescents identified as equally important. While the providers designed intervention to target 10-24 year olds, the adolescents preferred to have interventions that specifically targeted the study population 15-19 years. Most interventions were facility-based while, the adolescents desired community based outreaches. Conclusion The packaging and mode of delivery of interventions were perceived less holistic to meet the adolescents’ needs. Most interventions were designed to address the sexual and family planning needs while ignoring the wider social and livelihood needs. More holistic and outreach-based programming that addresses RH within the broader context of livelihood and sanitation requirements are more likely to be effective.

The Sexual and Reproductive Health needs and preferences of youths in sub-Saharan Africa: A meta-synthesis

“…Youths wanted services directly addressing their sexual and reproductive health issues. The need for a wide range of services was reported due to perceived gaps at local health facilities [67, 69, 71, 77-78]. This theme had two sub-themes: preventive services and treatment services .…”

“…Youths across all studies wanted STI testing and treatment services for issues like candidiasis, syphilis, and HIV/AIDS [65, 70, 71, 79]: “…when you get infected with diseases like Candida…we fall sick all of the time, the trenches here spread diseases due to poor sanitation” [71]. Reported lack of access may drive this demand: “She had been to Kasangati health centre and they told her that the drugs are not there…” [68].…”

A Realist-Informed Review of Digital Empowerment Strategies for Adolescents to Improve Their Sexual and Reproductive Health and Well-being

“…Many girls at this age are learning to negotiate relationships, while at the same time facing unwanted pregnancies and forced early marriages, or are being compelled to engage in sex work for economic motives [20]. Often, these adolescent girls do not have access to basic health and social services catering to their specific developmental needs [21].…”

“…Finally, there is often no time nor resources to adapt programmes to the needs of the urban adolescents in that specific setting as stated by Tuhebwe et al in relation to SRH programmes and adolescent needs in Kisenyi, an urban poor setting in Kampala, Uganda [21].…”

Contraception Decision-making Autonomy among Adolescent Girls and Young Women in Uganda: Implications for Self Care-oriented Family Planning

“…In addition, some self care-oriented FP methods such as emergency contraception, oral pills and condoms can be purchased and used without the support of a health provider [20]. Self care-oriented FP can easily be delivered through the existing channels preferred by young people in their respective communities, such as; the private sector (drug shops, pharmacies) [21] and the greatly desired community based models like community health workers and peer educators [22] with potential to overcome inequities based on age, education and geographic coverage due to the increases access at community level While self care-oriented FP services can potentially help achieve reproductive autonomy [23], the ability to use of self-care options can also be in uenced by one's extent of reproductive autonomy which is also in uenced by several factors like empowerment for decision making [24], partner involvement, the health system and socio-cultural issues. Women who are empowered to make reproductive health decisions are often in position to use contraceptives [25].…”