Structural & Ecological Approach Key To Advancing SRH Services Among Zim Youths

YOUTHS are a critical constituency in every given society and it is that period in life when one is young, and often refers to the phase between childhood and adulthood. The African Youth Charter defines youths or young people as every person between the ages of 15 and 35 years while the United Nations defines youth as persons between the ages of 15 and 24 and all UN statistics are based on this range.

By Enock Musungwini

Youths are a special group that requires carefully planned and specific programming to reach out and service. Young people are the future everywhere. Globally, there are 1.04 billion young people aged 15–24 years with 87% living in developing countries and is an estimated 18% of the global population (UNFPA,2000).

Effective sexual and reproductive health services provision for youths requires a lot of efforts and strategic planning particularly in low to middle income countries including Zimbabwe.

It calls for multisectoral and multidisciplinary approach in provision of such services to ensure long term and sustainable impact. This is mainly because there are lots of policy and broad changes to be done to the health delivery system in terms of pricing, service location and staffing levels.

Population Services Zimbabwe an affiliate of Marie Stopes International has done a lot in trying to reach out to youths in colleges and Universities and having Key Performance Indicators for reaching youths as a key deliverable.

Provision of adolescent, sexual and reproductive health services is a priority for all countries including Zimbabwe as enshrined in the UN Sustainable Development Goals (UN SDG, 2018). The Sustainable Development Goals (SDGs) launched at the start of 2016 created a vision for leaving no one behind and, in doing so, called for reaching those who are furthest behind first especially the special groups like youths.

Youths particularly young girls around the World continue to face multiple challenges in accessing SRH services especially the low to middle income countries. It is critical to put support programmes and mechanisms to ensure Zimbabwe and other sub-Saharan African countries are on the right track to achieve the SDGs by 2030 and fulfil the commitment to leave no one behind.

It is important to adopt the ecological model in addressing access to SRH services for youths and make the services youth friendly.

The ecological framework has four guiding principles with the first being recognising the multiple influences on health behaviours and outcomes including factors that operate at the intrapersonal, interpersonal, organizational, community, and public policy levels.

Secondly, it posits that these influences interact across these different levels while the third component looks at specific health behaviours and outcomes, identifying which factors are most likely to influence the specific behaviour or outcome at each level of the framework.

Lastly, the framework proposes interventions that address factors at multiple levels which have been found to be effective and useful. It is recommended that at the individual level, there is a need to focus on empowering youths including through efforts such as those that build the economic and social assets as well as the resources of youths.

Apart from that, at the relationship level, there is a need to build relationships that support and reinforce positive health behaviours of youths. In addition, the ecological model draws comparisons on the WHO Health Systems Framework which has the building blocks which are required to facilitate an enabling environment for effective services provision.

An enabling environment uses a comprehensive and holistic approach in addressing challenges. It involves different stakeholders and players in the health supply chain operating at different levels including individual, community and society level.

Furthermore, the ecological framework focuses on organizing the key elements of enabling environments for youths sexual and reproductive health including family planning services at different levels.  At the individual level, strategies to be implemented include empowering girls, building their individual assets, and create safe spaces for them to fully participate in personal and professional development. At the relationship level, strategies to be included are building parental support and communication with youths as well as peer support networks.

The framework at the community level focuses at the strategies to engage men and boys and the wider community to transform gender and other social norms so that there in support across the board.

Organisations such as Padare in Zimbabwe and Men Engage Forum in South Africa have done a lot in promoting laws and policies that protect and promote human rights including SRH rights with full and active involvement of men and boys. Apart from that, Safaids project on changing the Rivers Flow focusing on culture aspects that inhibit access to SRH services for girls played an important role in changing gender norms and stereotypes.

Taking a rights based approach gives an opportunity to youths and girls to claim their SRH rights and demand access to services.  In addition, it is also imperative that broad societal awareness programmes about ASRH issues including family planning are promoted through mass media campaigns in communities.

Another school of thought maintains that strengthening access to, and the quality of, services does not alone suffice to improve health outcomes. According to Avni Amin (PhD) of the Department for Reproductive Health Research at World Health Organization in Geneva, Switzerland, sexual and reproductive health (SRH) of youths is strongly influenced by a range of social, cultural, political, and economic factors and inequalities.

It is further noted that these factors increase youths vulnerability to SRH risks such as unsafe sex, sexual coercion, early pregnancy and maternal challenges.

Research has shown that addressing these underlying determinants requires working with various stakeholders such as parents, community members, and policy makers, is essential for adolescents to realize their SRH and human rights (Svanemyr et al, 2014; Turmen, 2000). It is further emphasised that building enabling environments so that adolescents realize their SRH and human rights requires interventions that work at multiple levels with adolescents, with families, with communities, and at the societal level.

An enabling environment reflects a set of interrelated conditions that include legal, political, social, and cultural that affect the capacity of young people to lead healthy lives and access relevant and necessary services, information, and products.

Creating an enabling environment requires addressing broad structural factors beyond the individual that are key to shaping ASRH outcomes that include family planning and post abortion care services as well as other aspects of health and development of youths. In addition, the ecological model provides a comprehensive framework for understanding the multiple and interacting determinants of the SRH behaviours and outcomes for youths.

This model has been seen to be useful and is widely applied in understanding determinants of a wide range of health behaviours and outcomes. It is important that SRH services including family planning and post abortion services are made universally accessible, available and affordable to the youths so that they fully utilise, access and demand the services.

This is in line with the Alma Ata declaration on primary healthcare signed in 1978, the 1994 International Conference on Population and Development (ICPD), the 2006 Maputo Plan of Action which aimed at achieving universal Sexual Reproductive Health and Rights in Africa by 2015 and the United Nations Sustainable Development goals (SDGs) number 3.7.1. This is important because Zimbabwe is a signatory to the important international, regional and sub-regional instruments.

Enock Musungwini is an MSc Public Health scholar at London School of Hygiene and Tropical Medicine in London, UK and a 2018-19 Chevening Scholar. He is an Advocate of Access to SRH and family Planning services for Youths and Served as a Committee member of the Zim-SADC Parliamentary Committee on SRH Services working with Parliamentarians and advising on SRH and Family Planning issues. He was Head of Population Services Zimbabwe Clinics 2016-18 and was nominated for an award for Marie Stopes International Best Clinics Champions for 2016 among 35 country programmes for the great achievements. Enock holds a Masters in Business Administration (Graduate School of Business Leadership, MSU), BSc Hons Psychology (Zimbabwe Open University), Diploma in General Nursing (Parirenyatwa School of Nursing) and Certificate in Health Leadership and Management (Graduate Business School, University of Capetown). He is also a Member of the Africa Evidence Network Reference Group, Zimbabwe Embassy UK Health Cluster Committee and Volunteer with African Diaspora Global Health Café. He can be reached on twitter @Enomark1979

The views expressed in this article are mine.


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