In December 2017, Uganda’s Bushenyi district chief administrative officer directed sub-county governments to allocate one percent of their total budgets to providing youth-friendly services, including family planning. This achievement is the second advocacy win resulting from Advance Family Planning (AFP) local partner Reproductive Health Uganda’s (RHU’s) efforts to integrate social accountability methods with the SMART approach.
In September 2017, RHU facilitated sessions to train young people on social accountability and their health rights. Youth-friendly services in Bushenyi are limited, despite adolescents (10 - 19 year olds) comprising approximately 30% of the population of more than 230,000 (Uganda Demographic and Health Survey 2014).
RHU worked with 20 young people in Mbarara and Bushenyi districts, equipping them with skills on how to use the social accountability tools—including RHU’s adaptation of the CARE International Community Score Card. The score card empowers communities to participate in providing essential information and constructive feedback.
Following RHU’s social accountability training, the youth participants visited health facilities in Mbarara and Bushenyi districts to converse with other young people and community members. Using the community score card, the young facilitators assessed youth access to health services, including family planning, based on a scale of 1 to 5 (very bad; bad; fair; good; and very good).
The score card exercise identified a number of issues, including: a shortage of trained staff in adolescent reproductive health, little respect for young people’s sexual and reproductive health and rights, outdated case management guidelines for family planning and sexually transmitted infection treatments, and no budget allocation for family planning.
With the evidence from the score card, RHU facilitated an AFP SMART strategy session with 10 young people from Bushenyi district in October 2017. They developed two objectives during this session:
- Bushenyi District council passes a resolution to allocate specific time for provision of youth-friendly services at all health centres in Bushenyi by January 2018, and:
- Bushenyi district council creates a budget line and allocates funds for youth-friendly services in the health sector budget by May 2018.
The young people used the score card results as evidence when making their asks at a meeting with the district council on December 8, 2017. The council responded affirmatively—passing a resolution for sub-county governments to create a new budget allocation (one percent of their total budget) for providing youth-friendly services. Although it seems small, the 1% commitment can amount to $1,000 or more per sub-county. District chief administrative officer Elias Byamungu sent out the directive promptly on December 19.
The budget allocation will go into effect in the 2018/19 financial year. In the meantime, leaders need to identify the right representatives for youth on the heath unit management committees, raise awareness among youth about available services, and support health workers with the integration of youth-friendly services. RHU will continue working with the young people to follow up on the directive and expected budget allocation.