Clubs promoting youth friendly health services
It is a Wednesday afternoon and youths of Traditional Authority (T/A) Kawinga are gathered at the health centre.
Some have come to access contraceptives, some to collect condoms, get Sexual Reproductive Health and Rights (SRHR) information while others are here to socialise with peers.
“I enjoy these sessions. I usually get answers to sexuality questions. On top of that, I’m able to access contraceptives of my choice without being judged or questioned,” says Alinafe Bello, Secretary for Chitetezo Youth Club.
The facility, which is located about 15 kilometres from Ntaja Trading Centre, is privileged to have Youth Friendly Health Services (YFHS) which youths of the area are speaking highly of.
Malawi’s YFHS national standards describe them as high-quality services that are relevant, accessible, attractive, affordable, appropriate and acceptable to young people.
The YFHS package of Kawinga Health Centre includes nutrition, HIV testing and counselling, Sexually Transmitted Infections (STIs) screening and treatment, health education and peer education.
Voluntary Medical Male Circumcision and Post abortion care are not provided.
YFHS Coordinator at Kawinga Health Centre, Francis Nthonga, says every Wednesday afternoon, from 2pm to 4 pm, youths flock to the facility as it is a special time for youths.
“Apart from health services, we also have various activities such as football, netball, chess, and snakes and ladders games to keep them active,” he says.
Chairperson of Chitetezo Youth club, Henderson Balaka, says he is pleased with the YFHS that Kawinga health facility provides to the youths.
“This is a remote area. Where the youth are not exposed to social media, they don’t know much. These services have come at the right time to us. We never knew that we had rights to access health services on our own.”
“We initially relied on our parents, who did not encourage us to seek medical attention. They just gave us native concoctions or took us to witch doctors,” he says.
Balaka acknowledges that the existence of youth clubs has helped to enlighten youths that girls can use contraceptives to avoid having unwanted pregnancies.
These youths have the support of elders of their community. They established a high level traditional leaders’ taskforce to strengthen and encourage them to access YFHS.
“We thought contraceptives are only for married women. But we have now realised that anyone who wants to delay pregnancy for various reasons can use them. We were afraid of meeting our parents and other elders at the health centre in the early days but we are now used to doing that,” Bello reveals.
Chitetezo Youth Club has 21 members, 10 boys and 11 girls. Some female members have children while others do not have any. These are using contraceptives.
Bello says the health facility offers them a variety of contraceptives and gives them the chance to choose the best suitable ones.
But Nthonga says Kawinga Health Centre is, somehow, failing to meet the demands of youths. He says the facility frequently runs out of family planning supplies.
“Youth Clubs from communities surrounding this area have done a great job in encouraging youths to be making use of our existing YFHS. But we are now failing to meet their demands, in terms of commodity supply and recreation activities,” he says.
Nthonga adds: “They are now requesting to be having disco as one of their recreation activities, but we have no equipment.”
It has been observed that youths prefer to use Depo provera (injectable) and implants (Jadel or Norplant).
“They say they feel safe with these methods. But we still advise them to use condoms because they provide dual protection; unwanted pregnancies and STIs,” Nthonga says.
In terms of oral contraceptives and condom administration to youths living far from the facility, he says Community Based Distribution Agents and Health Surveillance Assistants provide the commodities on its behalf.
Nevertheless, these, he says, are frustrated due to lack of supervision and challenges to do with mobility as their job requires them to move from one place to the other.
Nayuchi Aids Network Services (Nanes), a Machinga based youth organisation working in the area, has been assisting with family planning supplies to meet the current demand.
Nanes Executive Director, Chifuniro Moir, says mobility is a big challenge, so much that it is hard for health service providers to reach out to some youths who live far from Kawinga health facility.
“There is a high demand for family planning commodities out there as a result of massive awareness. The commodities used to expire but the opposite is true now, it’s becoming scarce,” he says.
Moir says Nanes has been providing supplementary family planning commodities to Ntaja and Kawinga health facilities in order to meet the rising demand courtesy of Southern African Aids Trust (Sat) and Tilitonse.
Much as youths of Kawinga, which happens to be a rural area, are privileged to have YFHS, youths of Blantyre are not in the same situation, despite being in an urban area.
Youth advocate for Graca Machel Trust in Malawi, Christina Chirimba, says she is not satisfied with how YFHS are delivered.
“When I heard about the establishment of YFHS, I expected it to be in full range and not the way it is. There is still a gap. The SRH services are still provided to the youth with a disapproving and discriminatory attitude,” she observes.
Chirimba says it appears other facilities are just doing it anyhow and health workers involved do not understand youth issues.
“Most youths don’t know if YFHS exist. So, in this case, you will find youths not demanding the services at all,” she notes.
Another Blantyre-based youth, alias Maria, says she has been accessing contraceptives from Zingwangwa health centre in Blantyre with no hustles.
“I don’t like condoms provided at government clinics. They don’t have flavour. It’s hard for me to buy flavoured condoms from retail shops, so I would expect the facilities to provide such to us,” she confesses.
Blantyre has 27 health facilities but only 10 have YFHS. District YFHS for Blantyre, Mary Wiseman, admits that most providers are not trained in the provision of YFHS, and that that is why some facilities are lagging behind.
“Untrained providers use the basic knowledge of YFHS they got during their nursing training. Untrained providers have inappropriate attitudes,” she says.
Wiseman says much as the district health office is interested in having youths accessing YFHS services, the programme is facing several challenges. The 10 facilities that are providing YFHS do not have equipment for recreation activities.
According to the Evaluation of YFHS in Malawi (2014), the implementation of the Malawi government’s YFHS standards are rated as medium.
Policy brief (July 2016) disseminated by Ministry of Health, titled ‘Strengthening the Delivery and Accessibility of YFHS’ done by Edward Zombe, notes that, despite efforts to provide the services, the uptake of YFHS by young people is limited.
A March 2015 Policy brief titled ‘YFHS in Malawi: Young People’s Sexual Experiences’ says YFHS are a key component of Malawi’s National Sexual and Reproductive Health ProgramMme and will help facilitate the attainment of Malawi’s Family Planning 2020 (FP 2020) commitment to achieve a 60 percent contraceptive prevalence rate, with a focused increase on those aged between 15 and 24 years.
“Managing the performance of the YFHS programme is one aspect of safeguarding young people’s transition into adulthood and of improving health indicators for the youths in Malawi,” reads part of the policy brief which was based on the evaluation of YFHS in Malawi funded by Usaid.
YFHS were established upon the realisation that adolescents and young people are exposed to a broad range of SRH challenges including unwanted pregnancies, STIs, HIV and Aids.
Malawi government introduced the YFHS programme in 2000. In 2007, the Ministry of Health-Reproductive Health Directorate (MOH-RHD) developed YFHS Standards with the aim of providing quality services to young people.
In 2014, the MOH-RHD and the Centre for Social Research, University of Malawi, with assistance from the USAID-supported Evidence to Action project, conducted its first comprehensive evaluation of the YFHS programme.
The youth of TA Kawinga seem to be on the right track as their youth clubs are used to wooing more youths to utilise YFHS. In his July 2016 policy brief on YFHS, Zombe also recommends collaboration with such youth groups, health and other service organisations and government agencies in making YFHS work.
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