Figure 21: Community leaders’ support towards SRH of young people

Health worker / Counsellor RAHU peer educator/worker Other peer educator/worker Other NGO / CBO (Specify) Village Health Team (VHT) Community group/club Religious leader Local leader/politician Others 5.63 4.93 5.63 3.52 2.11 7.75 13.38 8 7 8 5 3 11 19

When asked about the role that district and community leaders played in facilitating young people’s access to SRH during the lockdown, the majority (72.16%) of the caregivers/parents interviewed reported that no assistance was provided as indicated in figure 21 below.

Figure 21: Community leaders’ support towards SRH of young people.

0

Among those who could attest to the role of leaders in facilitating access to SRH, slightly more than a tenth (10.26%) mentioned provision of sensitization and education, while 9.15% talked about the issuance of movement permits. On the other hand, 6.5% of caregivers interviewed did not know any form of support extended by district and community leaders to facilitate young people’s access to and utilization of RH services during the lockdown.

80

72.16

70 60 50 40 30 20 10 10.26 9.16 6.59

0.73

No assistance at all To further understand the role of district and community leaders in facilitating young people’s access to SRH during the lockdown qualitative interviews were held with different categories of stakeholders including local leaders and peer educators. Findings reveal that district officials put in place various strategies to ensure continuous provision of SRH services to those who needed them, despite the challenges presented by the COVID-19 pandemic and the lockdown. The excerpt below from an interview with the DHO explains some of these measures.

Provided awareness & sensitization Issuing of movement permits Don’t know Supply of SRH products

The district covid-19 task force headed by the RDC allowed nurses with their work identity cards to move freely to and from the health facilities. They were referred to as essential workers and this enabled health facilities to open for young people to access the needed SRH services. However, the cost of transport more than doubled which worsened the problem services (District Health Officer, Mayuge)

These views above were reiterated by other respondents as reflected in the quotations below from the Secretary for Health and Social Services and another from a RAHU Peer Educator:

The district through the Taskforce facilitated processing or securing written and oral permissions for young people who wanted to access the services at different facilities. For example, those who wished to go for ant and post-natal care and expectant young mothers were supported (Secretary for Health and Social Services, Mayuge)

Yes, the local leaders like LCIs would give reference letters for people who wanted SRHR services during lockdown (Reach A Hand Peer Educator)

As captured in these testimonies, while the district leadership may not have been directly involved in the provision of SRH services to young people during the lockdown, a lot was done to eliminate the supply and demand-related barriers to access and utilization. Other interventions undertaken by the district include supporting information dissemination about the availability of services at the health facilities during the lockdown, coupled with conducting outreaches to extend services to young people in their communities.

We put announcements on the radio to let young people know the services that were available at health facilities and assure them that the facilities were open and encouraged them to go there and seek these free services (District Health Officer, Mayuge)

It was also reported that during the lockdown, the district health team enlisted the support of the VHTs in providing SRH services to young people as

Recruitment and training of VHTs to help in the sensitization of SRH services at the grass-root level. The interventions were quite effective especially for VHTs who did door to door delivery of SRH services like simple and short-term family planning methods for mothers (Secretary for Health and Social Services, Mayuge)

Used VHTs and other volunteers to take information and products directly to the users (District Health Officer, Mayuge)

The use of VHTs was also good because even during the lockdown, VHTs would visit us and give us SRHR information (FGD Teenage Mother – Buyere, Mpungwe Subcounty)

The Village Health Teams are an important component of the community health system in Uganda. In particular, the VHTs support the health workers in extending health services including sexual and reproductive health to remote areas that are often marginalized due to the lack of adequate staff at health facilities. As such, enlisting the support of VHTs to be an important strategy in delivering SRH in a period of crisis such as the COVID-19 imposed lockdown.

Another role of the district in facilitating access to SRH services to young people was ensuring the continuous supply of SRH products to health facilities to ensure uninterrupted delivery of services including by VHTs whose stocks were replenished:

The district ensured the provision and delivery of SRH products to the health facilities as well as supervision to ensure the continuous running of the facilities. Carrying out sensitization through radio and megaphones to encourage young people to go for the services was also key (District Health Officer, Mayuge)

As earlier reported from the results of the facility assessment, most of the facilities visited were able to continue the provision of most of the SRH services that were routinely provided to young people before the lockdown. This ensured that young people in need of services continued to enjoy a wide range of SRH methods and products with minimum interruption due to stockouts.

Despite this resilience exhibited by the district health structure to facilitate the continuous provision of SRH services, some challenges were experienced. For instance, delivery of health products and undertaking outreaches did not cover hard to reach areas as explained by the DHO:

These interventions however did not cover the entire district as some sub-counties are very hard to reach due to their geographical nature. These are Malongo located in a forest reserve and Jaguzi sub-county which is surrounded by 6 islands. These places largely remained without SRH services during the lockdown (District Health Officer, Mayuge)

As has been reported in previous studies, vulnerable young people including those in hardto-reach areas are often disproportionately affected by SRH issues. Therefore, a limited supply of SRH services during the lockdown would probably result in a disproportionate prevalence of SRH related problems such as teenage pregnancies, early marriages, and the associated consequences such as unsafe abortions, school dropout and reduced socioeconomic prospects.