Communique issued at the 3rd National Public Health and Health-care Symposium

INTRODUCTION

Public Health Ambassadors Uganda is a leading organisation on issues that affect adolescents and young people today. It is a youth-led and youth-serving organization comprised of young people who are passionate and interested in addressing key sexual and reproductive health issues in their own communities using health promotion, youth empowerment, social entrepreneurship and ICT for Health.

Public Health Ambassadors Uganda (PHAU) convened the 3rd National Public Health and Healthcare Symposium on 11 December 2019, in Kampala, Uganda. The theme of the 2019 Symposium was – “Opportunities and challenges of achieving Universal Health Coverage in regard to young people’s Sexual and Reproductive Health in Uganda.”

The objectives of the Symposium were to; Foster new ideas and home-grown solutions to Uganda’s most pressing health challenges with a focus on achieving Universal Health Coverage (UHC) by 2030; Map a pathway from commitment to action on UHC and build momentum among diverse stakeholders; Provide a safe space for young people to participate in critical discussions on the future of health decision making and ensure that they have a say in the policies affecting their health and futures, and to ultimately inform policymakers’ approaches to include the youth in UHC service delivery and implementation; and to provide a platform to enable young people to foster the exchange of good practices, strategies and commitments from youth organizations and networks to influence national and regional consultation processes related to UHC.

The annual event usually targets over 500 participants and it is an avenue for them to communicate, connect and collaborate on crucial public health needs and challenges at local national and international level.

The Symposium targeted Public health students (undergraduate, graduate and post-doctorate), healthcare professionals, members of the academia, researchers, policy makers and representatives from the Ministry of Health, Ministry of Education, Uganda Bureau of Statistics, National population council (NPC), National Planning Authority (NPA) among others.

PHAU engaged organizations whose key focus is on issues that affect young people. These included; Frontline AIDS, AMREF, Living Goods International, Naguru Teenage and Information Centre, CYSRA, UNYPA, ICWE, Wonetha, UYAHF, HRAPF, RAHU, and Peer to Peer Uganda, in the delivery of key Symposium activities. The activities were; panel discussions, sharing of experiences, best practices and challenges, oral and poster presentations and photo-voice exhibition sessions.

GROUP DISCUSSIONS

The theme was broken down into 5 sub-themes notably: – Governance; Health financing; Service delivery and coverage reforms; priority interventions; HIV/AIDS. Participants were split into smaller groups to discuss the subthemes in detail.

During the deliberations under the respective sub-themes, the following was noted:

The session on research/best practice presentations on Universal Health Coverage subthemes looked at a number of critical issues. In regard to Service Delivery and Coverage Reforms there are glaring knowledge gaps that are still persistent, particularly family planning access by adolescents (20 years and below). The concern was that adolescents know so little about Family Planning and that health care workers are in most cases not trained/well-trained to offer youth friendly services.

Another key observation was that on sustainability especially in regard to what happens when donor funding comes to an end. In addition, there were concerns on what happens when the technical people are not available to avail services to the communities. The response (from Marie Stopes) was that trainings are availed to health practitioners such as Emergency Medical Services (EMS) Staff so that they can deliver services effectively.

On HIV/AIDs – The discussion dwelled more on the differences between Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) and what the morning after pill (also known as the Levonorgestrel). It was noted that the PrEP is administered to discordant couples and it is for prevention, PEP is for post exposure prevention and the morning after pill is purely for emergency contraception purposes. All of them are used to prevent the spread of HIV/AIDS in different ways and they cannot be substituted one for the other. Maris Stopes informed participants that People living HIV/AIDS are included in the services that are offered to communities.

On Youth Engagement in Universal Health Coverage – Universal Health Care needs to be inclusive and one of the ways to do this is for Uganda to embrace the Youth Advisory Peer-to-Peer Services (YAPS) Model. Neighbouring states like Kenya have already embraced this model. The other observation was that health systems need to be designed in such a way that adolescents and young people own their health. They also need to own their decision making processes.

Participants also noted that health care systems need to be designed in such a way that they empower adolescents, youths and other community members to own their health. This includes decisions that they make regarding their health. Precisely, health care systems should not just curb challenges.

There were also general but very critical observations one of which was the need to include Persons with Disabilities in all health processes and programming so that their needs are presented by them and not on their behalf.

Participants noted a number of challenges per sub-theme, in achieving Universal Health Coverage as follows:

Sub Theme: GOVERNANCE

• Delays in approval of policies
• Limited access to youth friendly services
• Lack of inclusiveness in service delivery
• Human resource challenges at health facilities
• Limited participation and engagement of young people in development of policies
• Bureaucracy in government systems
• Failure to implement/fulfill policies
• Corruption/embezzlement in health facilities
• Poor M&E structures to monitor performance of facilities
• Poor documentation/lack of research based policy implementation

Sub Theme: HEALTH FINANCING

• Policies dissemination especially to the private practitioners is still minimal Results based financing (RBF)
• Worrisome funding (4% public, 96% private). Drug stock outs are frequent because government depends on donors to provide the commodities.
• Health workforce needs a boost in terms of numbers
• Limited Political will to prioritize health financing.
• Young people have no clear focus on health financing issues.

Sub Theme: HIV/AIDS

• Stigma and discrimination still prevalent when it comes with people living with HIV/AIDS
• Poor drug adherence (resistance HIV strains)
• Poor support system of people living with HIV
• Leadership at health facilities is discriminatory (in terms of attitudes towards HIV).
• Health information system is not streamlined
• Varying information

Sub Theme: PRIORITY INTERVENTIONS

• Limited awareness of services available.
• Inadequate funding to health facilities.
• Inaccessibility of services
• Poor political presentation of youth.
• Limited skills for social accountability.
• Lack of empowerment.
• Social norms
• Lack of structures and guidelines
• Limited safe spaces
• Unemployment and affordability
• Stock-outs of commodities and essential materials.
• Human resource gaps.
• Lack of data for decision making

Sub Theme: SERVICE DELIVERY AND COVERAGE REFORMS

• Limited awareness of services available.
• Inadequate funding to health facilities.
• Inaccessibility of services
• Poor political presentation of youth.
• Limited skills for social accountability.
• Lack of empowerment.
• Social norms
• Lack of structures and guidelines.
• Limited safe spaces.
• Unemployment and affordability
• Stock-outs of commodities and essential materials.
• Human resource gaps.
• Lack of data for decision making.

RECOMMENDATIONS

Following the discussions, the following recommendations were arrived at:

• Implementing partners should advocate for policies that enhance effective service delivery.
• Modern technology should be utilized to enhance service delivery e.g. self-testing for HIV.
• Increasing financing for health in government budgets is critical
• There is need to use sign language interpreters for PWDs (blind, autistic) to enhance service delivery.
• Continuous training of health workers, increased remuneration, and even distribution of health facilities are all steps in the right direction.
  Provision of relevant information on available health services to the population to create demand for services is key.
• The Multi-sectoral approach to work is important in realising UHC e.g. working with religious leaders, media advocacy, etc.
• Youth inclusion in policy making, leadership and planning.
• Skilling the youth with advocacy skills to hold leaders accountable is needed.
• Mechanisation of Health Sector Information Systems needs to be embraced.
• Empowerment and protection of people living with HIV/AIDS from stigma cannot be overemphasized.
• Doing away with myths and misconceptions on health related issues and about HIV/AIDS
• Having regulations and standards on health care products is key.
• Dissemination of the health policy to all stakeholders should be done.
• There is need for increased funding, leading to training of health workers and increasing the recruitment of health workers, building of Health Systems, increasing accessibility, increasing family planning commodities
• There is need to implement and disseminate the Sexuality Education Framework
• There is need to promote youth friendly services so that they can access and utilise the services meant for them,
• There is need for Public-private partnership strengthening
  Investing in research to generate evidence for interventions
• Bottom up approach to foster community participation, inclusion and diversity

CONCLUSION

Participants at the meeting concluded that: there is need for tailored information, meaningful youth engagement, participation and effective community-based policies; Achievement of HIV/AIDS epidemic control (incidence reduction); a gender responsive, high quality and youth inclusive UHC; and access to quality health information and services country-wide.