1. Adolescent Girls’ Sexual and Reproductive Health Service Delivery in Uganda: Evaluating Progress in Implementation of the National Adolescent Reproductive Health Policy
A presentation By
Agnes Kyamulabi (Dept of Develoment Studies, Makerere University)
Opesen C. Chris (Dept of Sociology & Anthropology, Mak-University)
AT THE SOCIETY OF ADOLESCENT HEALTH IN UGANDA (SAHU)
 4TH SYMPOSIUM OF MAKERERE-COLUMBIA (MUCU) MEETING
Kampala, Uganda
29TH MARCH 2017
 VENUE: HOTEL AFRICANA, UGANDA

2. Introduction
Adolescent girls as a vulnerable group face many social change crises as they transition from childhood to adulthood
Coupled with most sexual encounters in this age group being unprotected, these vulnerabilities increase their risk of getting unwanted pregnancy, engaging in an unsafe abortion, contracting STls/HIV.
The National Adolescent Health Policy was hence developed in 2004 with 12 key objectives and over 20 targets partly, to promote adolescent girls SRH.

3. Objective of the paper
On this backdrop, this paper provides a functional evaluation of the progress made in the implementation of this policy

4. Methodology
Evidence presented is based on 2 MoH key informant interviews
a realist hermeneutic review of
UDHS panel data(2001, 2006, 2011 and 2016)
National census data 2014 and 2002
IP ASRH reports particularly, UNICEF, UNFPA
NGO reports
MoH data from 2005 to 2015 vis-à-vis the 2004 policy targets.
Analysis and interpretations were inductively and thematically conducted

5. Findings: Progress in the National ASRH Policy Indicator Targets
Indicator Progress
Counts (n)
Per cent (%)
Negative 1
3.7
No progress 2
7.4
Very low
Low 4
14.8
High 5
18.5
Target Close
Target exceeded
No data 9
33.3
Target Not SMART
Total 27
100

6. Findings: Progress in the National ASRH Policy Indicator Targets
Negative Progress indicators: 3.7% (n=1, N=27)
Harmful traditional practices(e.g. FGM) through appropriate policies, legislation and programmes reduced
Target: Not stated.
Status: From 0.5% (UDHS 2006) to 1% in UDHS Detailed UDHS not out. Not reported in UDHS 2001
No Progress Indicators: 7.4% (n=2, N=27)
(a) Abortion law reviewed with a view to improve the services
Target: Have abortion law reviewed
Status: No review done since (Hansard 2017)
(b) Use of emergency contraception integrated in family planning programmes targeting adolescents increased.
Target: Use of emergency contraception integrated ……
Status: No integration since (UDHS 2001/2017)

7. Findings: Progress in the National ASRH Policy Indicator Targets
Very low Progress indicators: 7.4% (n=2, N=27)
(a) Double contraceptive use among sexually active adolescents
State of contraceptive use in 2004: 21.5% (UDHS 2006) Target 43% Status : 21.9% (UDHS 2016)
(b) Raise the median age at first sexual intercourse to 18 years from 16.7 in females
Median age in 2004: 16.7 years (UDHS 2006) Target 18 years Status: 16.8 years (UDHS 2012)

8. Findings: Progress in the National ASRH Policy Indicator Targets
Low Progress Indicators: 14.8% (n=4, N=27)
(a) STI management and HIV/AlDS counselling integrated in all activities at all levels of care
State in 2004: 28.2% (MoH 2006) Target 100% Status: 68% (UDHS 2012)
(b) Enrolment: Girl-child enrolment and retention in primary schools increased to match that of boys
State in 2004: 0.95 (MoH 2006) Target: 1, Status: 0.98 (SPR 2014)
(c) Enrolment: Girl-child enrolment and retention in secondary schools increased to match that of boys
State in 2004: 0.79 (MoH 2006) Target: 1, Status: 0.81 (SPR 2014)
(d) Reduce the % of women who have their first child below 20 years
State in 2004: 59% (UDHS 2011) Target: 30%, Status: 25% (UDHS 2016)

9. Findings: Progress in the National ASRH Policy Indicator Targets
High Progress Indicators: 18.5% (n=5, N=27)
(a) Lifetime risk of maternal death in age group 15-24years reduced by 50%
State: in (UDHS 2012) Target Status: for (UDHS 2016)
(b) Percentage of mothers below 20 years receiving at least two doses of Tetanus Toxoid during pregnancy increased
State in 2004: 56% (MoH 2004) Target: 80% Status: 74.3% (UDHS 2016)
(c) HMlS desegregated data on immunization, and nutrition status or breastfeeding status obtained for children born to adolescent mothers in order to design appropriate interventions
State in 2004: 48% (MoH 2004) Target: 100%, Status: 78.6% (UDHS 2016)
(d) Proportion of adolescents that are comprehensively knowledgeable about STls and AlDS increased
State in 2004: 29% (MoH 2004) Target: Not stated Status: 40.7% (UDHS 2016)
(e) Review, enact, enforce and implement legislation that will reduce harmful traditional practices
State in 2004: No FGM law Target: Not stated Status: FGM law in place (Hansard 2010)

10. Findings: Progress in the National ASRH Policy Indicator Targets
(a) Target Close Indicators: 3.7% (n=1, N=27)
Improve the proportion of mothers below 20 years delivering in a health facility
State in 2004: 48% (MoH 2004) Target 80% Status: 78.6% (UDHS 2016)
(b) Target Exceeded Indicators: 7.4% (n=2, N=27)
Increase the practice of dual protection in sex (against both disease and pregnancy) among adolescents by 30%
State in 2004: 49.8% (MoH 2004) Target 80% Status: 81.8% (UDHS 2016)
Increase the perception of the risk of getting HIV/AlDS in adolescent females
State in 2004: 68% (MoH 2004) Target 90% Status: 99.3% (UDHS 2012)

11. Findings: Progress in the National ASRH Policy Indicator Targets
No Evaluation Data Indicators: 33.3.% (n=9, N=27)
Ratio of girls : boys in tertiary education. the target is 1 and the SPR (2014) puts it at but there is no bench mark data
Increase the proportion of adolescents abstaining from sex before marriage by 30%.****
Pregnant school girls to continue with education system after they have delivered
Proportion of orphans with HIV accessing home based care and support increased
Proportion of HIV positive adolescent accessing ARVs increased (29% today-MoH 2015 but no bench mark data)
Adolescent reproductive health incorporated into the curricula of all health training institutions and schools. 
Increase the number of institutions providing psychosocial support services for adolescents   
Number of adolescents accessing psychosocial support services for the assessment and management of mental/behavioural disorders increased   
Establish psychosocial support   
****Median age for marriage in girls is 16.8 and 22.3 years in boys but there is no data measuring abstinence before marriage (UDHS 2001/2012)

12. Findings: Progress in the National ASRH Policy Indicator Targets
Non SMART Indicators: 3.7% (n=1, N=27)
Establish psychosocial support   
Others not included in the computation of the proportion but are not SMART
Harmful traditional practices through appropriate policies, legislation and programmes reduced
Review, enact, enforce and implement legislation that will reduce harmful traditional practices
Increase the number of institutions providing psychosocial support services for adolescents

13. Conclusion and Recommendation
Progress has been made in the last 13 years but ASRH policy effectiveness is observed in only 7.4% (n=2) of the 27 target performance indicators which is very low.
The state of some target performance indicators is not SMART rendering measurement of progress complex.
UNFPA and UNICEF evaluations in the area of ASRH do not capture all the indicator performance targets of the National Adolescent Health Policy. This is also true of the UDHS.
Recommendations
To strengthen evidence based decision making. MoH, its IPS, other development partners and the UDHS should align their ASRH related evaluations to the national policy indicators to ease performance assessment efficiently and provide timely data.
There is need to review the national policy indicators to be SMART.

14. Thank You
For your valuable
Attention