Lack of youth friendly services in Zimbabwe
“I was just waiting to raise enough money to go to a clinic outside”
Von Beatrice Savadye
In response to the extraordinary range of sexual and reproductive health challenges facing many young people in Africa, various strategies and interventions have been put in place by different players in the health field yet all these efforts are still far from achieving universal access by young people.
Youth in Zimbabwe typical of countries in the African Continent decry limited youth friendly services at the point of health service provision. The SAYWHAT Research Report of 2009/ 2010 revealed absence of post abortal care services within colleges, limited HIV testing and counselling services, limited support for youth living with HIV and limited range of contraceptives with only the male condom being distributed mostly.
The Students And Youths Working on Reproductive Health Action Team (SAYWHAT) was founded by students with students for students in 2003 to address the sexual and reproductive health challenges in Zimbabwe's tertiary institutions. It is a platform where students can discuss their SRH concerns and inform relevant advocacy issues. SAYWHAT focuses on reproductive health because students are sexually active and there is a high prevalence of unplanned pregnancies leading to unsafe abortions and of sexually transmitted infections (STIs) including HIV and AIDS.
Limited access to health care services
Recently I had a first hand account with the challenges young people have in accessing quality health care services. I was diagnosed with a cyst. The whole process from the doctors’ consultation to referrals for an abdominal scan and a gynaecologist was not youth friendly that I almost gave up on seeking the services I so much needed. Besides being a fully paid up member of a medical aid provider, I was requested to pay $40 for my operation and incurred either out of pocket costs which are usually a barrier to youth accessing health care services.
Through my experience and the encounters of other young people I have realised that limited access to health care services is due to factors ranging from high user fees, stigma, limited youth friendly services, poor referral systems, lack of follow up care and other structural inhibitors such as the absence of linked services.
“I could not seek STI treatment at my college because Gogo (an old college nurse) tells other youth about my illness so I was just waiting till I could raise enough money to go to a clinic outside campus,” said one female student who received support from SAYWHAT under its Test and Treat Campaign.
It is due to these factors that most young people delay to seek treatment and at times find it difficult to disclose their HIV status to their partners making positive prevention difficult.
These challenges also exist at structural and policy level where policies are not interrelated to support of SRH and HIV linkages. For instance there is reflection of Lesbian, Gay, Transgender and Intersex (LGBTI) persons as a priority area in the Zimbabwe National AIDS Strategic Plan 2 (ZNASP). Yet there are punitive laws and a hostile environment that makes it difficult for LGBTIs to access treatment.
According to the UNAIDS/WHO Report on the global AIDS epidemic (2010 ), 4.9 million young people aged 15-24 living with HIV need information and services for pregnancy prevention and pregnancy care (including Prevention Mother To Child Transmission PMTCT). According to the same report a further 569,000 women aged 10-24 are infected with HIV every year (i.e. 64% of 890,000 young people).
Most youth in tertiary institutions fall within this age range calling for the need to offer comprehensive health care services within colleges. In the absence of a tertiary education support grant system, integrated services and an effective medical aid system would be ideal in promoting access to health care services by youth.
Economic challenges, sugar daddies
Against common belief that, youth who afford to get in tertiary institution have some form of resources, most of them are self-supporting and less priority is given to them on both family and national level. These young people are regarded as mature and able to look after themselves in environment.
Most of the sexual and reproductive health challenges are deeply rooted in the economic hardships youth face. A culture of pioneering is observed within the student community with a lot of the young people shouldering responsibilities such as paying for their own food as parents fail to do so due to the paltry salaries they earn against the high tuition fees. “The course I am doing is very draining financially and at times young women are left with no option but to go out with sugar daddies who finance their studies”, said one student during thematic group discussions on multiple concurrent partnerships.
The student community bring together youth from different backgrounds with various sexual and reproductive health challenges, with some being parents and some having their first sexual encounters when they enter colleges. With this diverse background, the college clinics need to offer comprehensive services ranging from wide range of contraception to HIV testing and counselling, psycho social support for youth living with HIV and other family planning services.
Linked sexual and reproductive health (SRH), HIV and gender programmes have shown improved access to and uptake of SRH and key HIV services, better access by People Living with HIV (PLHIV) to SRH services tailored to their needs and improved quality of care. Linked services also helped to reduce HIV–related stigma and discrimination, and supported dual protection against unintended pregnancy and STI including HIV.
The government as the main duty bearer has a key role to play in addressing the challenges being faced by young people in Zimbabwe. There is need for health budgeting for youth as well as policies that are youth friendly.
Also donors have a role to play. Donor specific interests in HIV or SRH and conditionalities on use of funds for specific HIV or SRH interventions promote territorialism and inhibit SRH and HIV linkages at program implementation level.