Leonard Bufumbo is a research associate with FHI in Uganda. He worked on an operations research project focusing on voluntary counseling and testing with youth. The project was funded by USAID in 2000–2002 and implemented by Sociology Department of Makerere University, Kampala, Uganda.

As part of a youth assessment in Uganda, I led a team of data collectors in an effort to understand the sexual and reproductive health needs of youth. Our study consisted of focus group discussions with young people, interviews with government stakeholders, and assessments of health facilities that young people reported as being “youth-friendly.” Observations from this assessment confirmed that youth in Uganda face a number of challenges. Rates of teen pregnancy are high, use of family planning is low, and adolescents face many difficulties in accessing care.

After this trip, this is what I think. Youth have not yet been understood. The health workers think they understand them, but they don’t. That’s the biggest challenge! When young people present a complaint to a provider, the complaint often does not reflect what they truly need. When youth seek services, they often seek help with psychosocial issues that have more to do with relationships, both sexual and non-sexual, than they do with clinical issues. Sometimes, youth will even go to the clinic, not report anything at all, and just hang idly around. The youth do this because they believe it will provide them an entry point to services. These same youth will continue to try and access services, and sometimes they have to bring up the same problem at every visit to a clinic. Can you imagine? While this trend demonstrates positive health-seeking behavior among youth, it clearly shows that youth are not receiving the treatment that they really need. Furthermore, the service statistics reflect the issues youth initially report, NOT the real issues faced by youth. 

In addition to the communication barriers, it seems clinic staff may simply not have enough time to deal with youth issues. Staff workload and staff shortages seem to take a toll on providers. Remember, these clinics are not only serving youth; there are many other members of the population that cannot be ignored.

Currently, there is an ‘impunity gap’ between national youth policies, guidelines, and strategies and the actual care provided at public health facilities. It is truly alarming! Something needs to be done structurally, behaviorally, and professionally to lessen this gap. 

One way to immediately address this issue may be through peer networks. Peer educators can have great influences on peer members. Peer networks should focus on using positive deviance to sustainably change behavior; I believe this can be done without compromising the structure of the peer network.

While most of us enjoy working with youth because they are fun, we cannot forget that they are also vulnerable. There is still much that needs to be done to ensure that the reproductive health needs of young people are met.

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