Reaching the Unreached: Improving Sexual and Reproductive Health Rights Programming for Out of School Young People

This 91-page report presents findings from a baseline survey conducted among out of school young people aged 11-20 in Kampala, Uganda, to better understand existing knowledge, behaviour, attitudes, and practices related to sexual and reproductive health (SRH). The research also sought to identify suitable options and methodologies to produce media outputs, understand the information needs of out-of-school young people from their own perspective, as well as from the perspective of other stakeholders, and gain information on the participation of out-of-school young people in developing programmes and policies. The baseline survey was intended to inform the "Reaching the Unreached: Innovative Sexual and Reproductive Health Programming with Most at Risk young people in Kampala", a project by Panos Eastern Africa in partnership with Uganda Youth Development Link. The study established that this is the most vulnerable, at risk and urbanised population, most of them are unemployed, orphans, some are on the street, and others are adolescent commercial sex workers.

The study used both quantitative and qualitative methods of data collection – focus group discussions, key informant interviews, observations, documentary review, and a survey. It was conducted in April 2010 in Kawempe and Rubaga divisions, Kampala. One hundred and sixty interviews were conducted with out-of-school young people: 102 female and 58 females. These were supplemented by 6 focus group discussions of male and female out-of-school young people. Thirteen key informant interviews were conducted with programme officers working with the out of school young people, local council officials, and parents in the area where the study was conducted. The analysis of all the data that were collected was informed by descriptive, interpretative, and explanatory approaches guided by content and thematic analysis.

The key findings of the study are as follows:

• Policies and Programmes: The study findings show that the government has put in place several policies and laws addressing some of young peoples' sexual and reproductive health needs including HIV and AIDS. However, full implementation of some of these policies have not occurred because some are not known, disseminated, or popularised to relevant policy makers and programmers. There are also no policies that specifically highlight out-of-school young people, rather they view young people as a homogenous category.
• Issues/problems that affect out-of-school young people: The study established that this is the most vulnerable, at risk, and urbanised population, most of them are unemployed, orphans, some are on the street, and others are adolescent commercial sex workers. Being mobile and socially marginalised, this group needs extra effort and specifically designed interventions.
• Main sources of information: The main source of SRH/HIV and AIDS information was from sensitisation meetings conducted in the communities where these young people live. They reported meeting in particular places such as schools and churches, where the health workers teach them issues regarding HIV and AIDS, STIs, and family planning. In addition, when they visit a health facility for testing, they are counselled and sensitised on prevention. They also got information from radio programmes designed for young people.
• Contraceptive Knowledge and Use: The majority of young people reported that they have heard of condoms (98.7%), used one (55%), and are currently using (42.4%) them. This was followed by the withdrawal method at 12.9%, 9.5% were using injectables, and about 7.7 % were using the rhythm method.
• Knowledge about STI: Most young people were knowledgeable about the types of STIs and ways of preventing them. They commonly mentioned gonorrhoea (85%), syphilis (86.6%), and candidiasis (60.2%), but had less knowledge on other STI such as genital sores/ulcers.
• Participation of Young people: It was established that young people would be willing to participate in the programme if it has an income generation component. Becoming volunteers' without some incentive may not attract groups that are very poor. It was also deemed important that any programme for them needs to involve them in planning, implementation, and monitoring.
• Where the programme should be developed: The programme could be developed at the community level utilising community structures and premises such as a parish hall, the churches, or Kampala City Council. It was felt that if the programme is community-based with community-based structures, it would be cheaper, more acceptable, and accessible.
• How the programme would be disseminated widely: The programme would use Information, Education and Communication materials, brochures, and word of mouth to reach out as widely as possible. Young people could also be mobilised, recruited, and trained as the first batch who will act as ambassadors, peer educators, or peer mobilisers so that they go and advocate for the programme to their fellow young people. The local leaders need to be involved so that the programme is very well known at the community level. Radio programming where the out-of-school participate as facilitators or co-facilitators was advocated for.

Based on the findings of the baseline assessment, the following recommendations were made for strategic information and service needs and programming for the out-of-school young people in urban slums of Kampala:

• Out of school young people in Kampala live in an unfriendly volatile environment:They have several pressing needs such as accommodation, food, employment and parental guidance and therefore a safe and supportive environment is advocated for in order to reduce the risks of unprotected sex – HIV/STI infections and unwanted pregnancies. This should be a concerted effort of NGOs, community members, parents, local leaders, and the young people themselves.
• Mobilisation of out-of-school young people: Use the local council officials in the community to mobilise and sensitise them as they can easily penetrate areas where these groups live. Behaviour change can also be positively changed through peer mobilisation/sensitisation – Young people can be easily influenced by peers.
• Involvement: It would also be feasible to partner and work with community leaders and youth groups in the areas where the programme will be implemented as they are an important link between the young people and the ongoing interventions. There is a need to involve out-of-school young people in every stage of the programme.
• Partnerships: There is need to work with government institutions to provide the much needed health care and psychosocial services for the youths. Explore areas of partnership with other stakeholders such as Uganda Youth Development Link (UYDEL) in slum areas of Kampala.
• Youth-friendly health services: Out-of-school young people need to be provided with friendly services in order to reduce self perceived stigma among them. This will enhance their health seeking behaviour. The youth corners should be revamped to provide the information they need. In addition, outreaches should be put in place to reach those who may not access the health centres.
• Messages for advocacy: These should be done with the young people so that they can advocate for what they want from stakeholders and also help to change the public perception of out-of-school youth as a hard-to-reach difficult group, consisting of street boys and girls, sex workers, drug users and thieves.
• Income generation:In addition to accessing HIV and AIDS services, the young people should be organised in groups with structures so that they are linked to ongoing government programmes.