Monday, 15 April, 2019
By Maria Tororey, Paediatrics and Adolescents Officer, Amref Health Africa in Kenya
Universal Health Coverage strategies aim to avail appropriate, effective and affordable interventions to improve adolescent health. According to the World Health Organisation (WHO), to make progress toward universal health coverage, a number of transitions in service delivery, workforce capacity and financing will be needed. Adolescents living with HIV and AIDS (ALHIV) represent a vulnerable group as they not only experience issues that affect people living with HIV, but also those that affect adolescents as they grapple with physical, emotional, cognitive and social changes.
The ‘UHC in Africa Framework for Action,’ proposes five sets of actions. Under these, I suggest that adolescent responsive services must be considered while addressing ‘Services’ ensuring that pre-service training for the health workforce covers the needs of adolescents and that multi-sectoral partnerships, such as those between the Ministry of Health, Ministry of Education and all departments serving children, are strengthened and sustained. Under ‘Equity,’ there in need to recognise ALHIV as a vulnerable population while respecting the rights and entitlements of all adolescents.
Under the six UHC key points for adolescents, it is important for individual-level factors as well as organisational and structural factors to be considered. This includes transitioning from adolescent-friendly projects to adolescent-responsive health systems. Adolescents may develop health-related behaviours that expose them to more health risks than younger children. Peer influence limits their capacity to modify behaviour. Responsiveness implies that services should be tailored to suit each adolescent’s unique needs especially for ALHIV who have an array of challenges to overcome including stigma.
The expansion of services beyond sexual and reproductive health is also necessary. This is because ALHIV require support for holistic wellbeing including psychosocial support for ART adherence and positive living, nutritional support, life skills training and referrals between various service delivery points. Adolescents are less empowered than adults to claim rights in health service delivery, but have greater capacity than children to seek health care independent of their parents. They have limited access to resources and this may limit their access to health care especially if they have to open up to parents/guardians on their reasons for seeking health services. ALHIV may have more health care needs and require more financial support to access health services creating the need for pooled prepaid sources of funds to include priority services for all adolescents. Due to their limited rights to consent to some services, adolescents should be supported to engage with their parents/guardians so as to access all the required services.
The provision of quality standards should start with the training of health care providers in adolescent health and adolescent-responsive services including special needs of ALHIV. The health of adolescents, social needs and rights should be incorporated in assessment tools. Each adolescent is unique and requires patience and a non-judgmental attitude in order to open up. ALHIV desire confidentiality and autonomy in health consultations, pre-service training of health care workers on adolescent health and development and their implications for clinical practice is therefore of utmost importance.
Expanding coverage includes mainstream services, school health services, e-health and m-health. Limited capacity to perceive long-term risks and lower health literacy in comparison to adults predisposes adolescents to several health risks. UHC for adolescents should focus on preventive and promotive health services which are likely to reach more adolescents if integrated with school health services and delivered through present-day technological solutions.
In conclusion, UHC for adolescents should start with well-designed adolescent-responsive health systems from financing, workforce capacity and service delivery. Special consideration should be given to ALHIV and meaningful engagement of these adolescents during decision making for more effective strategies and better health outcomes. Some of the other roles that adolescents and youth leaders living with HIV can play include: community mobilization for HIV prevention and testing; education on health topics of interest and in a language best understood by the youth; service provision such as peer support and navigation within the health system; and be positive role models in their lifestyle and behaviour.
This year’s Maisha HIV and AIDS Conference taking place in May will present an opportunity for young people to provide better insights into what they would like to see for HIV prevention and care.
This article was first published HERE on 8 April 2019, by The Daily Nation.