ROAD MAP FOR IMPROVING ADOLESCENT HEALTH IN UGANDA April 11-15, 2016

Background . Globally adolescents constitute approximately 20 % of the population - 196.5 million adolescents in Africa Uganda has a predominantly young population with 70% being less than 25 years and adolescents (10-19 Years) specifically constituting 35 % (8.48 million) This has consequences; A young population is highly dependent and vulnerable and also presents serious challenges of addressing their sexual and reproductive health and rights and other conditions If not addressed, undermines social transformation and sustainable development

Background WHO estimates more than 33% of the global disease burden and 60% of premature deaths among adults can be associated with behaviors or conditions that arise during adolescence. State of the Worlds’ Adolescents: A Second Chance in the Second Decade 2014 The burden of health problems in adolescents includes; >2M living with HIV globally, the majority in sub-Saharan Africa including Uganda. 120 M girls <20 yrs. are victims of sexual violence 80% of adolescents are insufficiently physically active. Other problems such as mental illness, substance abuse, and tobacco and alcohol abuse are also now prevalent Lack of accurate and up-to-date data is a major challenge and adds to the potential for neglect and underinvestment

Uganda Still ranks among the top 10 countries with high maternal, newborn and child mortality rates Adolescents aged 15-19 contribute about 28% of deaths due to pregnancy related conditions. Has one of the highest HIV incidence among adolescent/young people An estimated 20% of young people experience some form of mental illness Female genital mutilation (FGM) and child marriage is rampant; Sebei and Karamoja sub-regions UDHS 2011 References

Uganda Uganda’s Vision 2040 has pronounced harnessing the “demographic dividend” as one of the key strategies for realizing social and economic transformation For the abundant youthful human resource to be converted into appropriate human capital it must be healthy, educated and properly skilled In the Health Sector, the RMNCAH Sharpened Plan 2016-20, sets out to translate Vision 2040 and the Global Strategy for women’s, children’s and adolescent’s health

Uganda MoH is working to align and update existing individual program implementation strategies with the RMNCAH sharpened plan A one-week retreat was held in April 2016 to develop a roadmap for improving adolescent health Intended to provide a direction for the government and stakeholders Identified several actions to be taken in the period between April 2016 - March 2017, to address ongoing challenges and to accelerate a set of comprehensive interventions for adolescent health and improve coordination among key players.

Key Achievements Increasing International Guidance Sustainable Development Goals Global Strategy for Women, Children and Adolescents Enabling policies and frameworks Increased advocacy The RMNCAH Sharpened Plan 2016 – 2020 National Multi-sectoral Task Force on the Adolescent Girl The National Technical Working Group on Adolescent Health The National Adolescent Conference

Persistent Barriers to Scale Up Lack of coordinated; Leadership, Management and Implementation Low prioritization; National RMNCAH program agenda Impaired implementation; dissemination and update of policies and mentorship and supervision The legal environment and weak enforcement

The Adolescent Health Roadmap The opportunity now exists to build on past knowledge and experience to embrace recent momentum to move forward and reduce the burden of adolescent health problems Indicates priority strategic areas for implementation of comprehensive evidence based interventions based on a multi-sectoral approach It’s CHIEF aim is to outline key actions to be taken by government and its partners

Leadership, Management and Coordination Dedicated budget and funding Dedicated human resource at all levels Review and update the current ADH policy and Strategy to align with country and global commitments Costed implementation plan

Adolescent Health Service Delivery Adaptation of the WHO Quality Standards of Care as a strategy to improve service delivery Review the existing minimum SRH Package of ADH Services to include other health problems and to determine modes of delivery of services including at Communities and Schools. As a pre-requisite, capacity building of the health system should include upgrading, equipping and organizing health facilities to deliver adolescent responsive services

A Comprehensive RMNCAH Communication Strategy Social mobilization and advocacy are critical for expanding from a disease centered model to include broader issues of Adolescent Health There is need to map the current communication strategies for RMNCAH and to identify gaps that can be addressed by developing a comprehensive Adolescent Health Communication Strategy Vital that we develop an advocacy strategy for laws and regulations that protect adolescents and promote adolescent health and wellbeing.

Updated Tools and Guidelines The roadmap recognizes the need to build capacity of health workers through training and mentorships, emphasizing a complete package of adolescent health services Existing tools on ADH should be reviewed and updated including; Developing relevant guidelines for in-service and pre-service training on ADH Training materials for ADH for national and regional trainers Update job aids for health care providers.

Strategic Information for Adolescent Health Urgent need to have a comprehensive list of indictors that can track progress of the wide adolescent health interventions Prioritized development of a comprehensive M&E framework to track progress of activities The indictors will be adapted from the WHO suggested list of indicators Age and Sex disaggregation

Operational Research and Documentation of Best Practices Ensure that the interventions are based on up-to-date evidence and are cost effective Set bench marks against which progress will be monitored - baseline studies Priority research areas will be identified and country adolescent health research agenda developed Through collaboration and coordination with Research institutions, Universities and partners research will focus on identified priority areas using innovative approaches like the U-report.

Collaborative Partnerships The ADH program should be government driven and implemented in a collaborative manner engaging relevant stakeholders as appropriate at various stages to ensure a multi-sectoral approach A framework for collaboration will be developed with clear roles and responsibilities for implementation of a comprehensive adolescent health and development program.

Next Steps The road map was presented to Ministry of Health top management and approved in October 2016. Adolescent Health Policy and Strategy revision process has started Costed Implementation plan