To mark the International Day for the Eradication of Poverty last week (17 October), we spoke to Arafat Kabugo, who is based in Uganda and advocates for improved reproductive, maternal, newborn, child and adolescent health. We spoke to him about the current health challenges in Uganda and why it is so important that young people are involved in the process of designing solutions that have a direct impact on their lives.
Alongside other advocacy roles, Arafat is also co-chair of the Global Youth Platform, which mobilises youth engagement in advocacy relating to improved health outcomes for women, children and adolescents. The Global Youth Platform is part of the Global Financing Facility (GFF), a global partnership which supports countries to build health systems that benefit women, children and adolescents. Within each country, it works with the country government as well as civil society organisations, including youth organisations, to develop a set of high priority investments for women, children and adolescents which in turn helps to align and leverage further financing.
Why is it so important that young people are involved in developing solutions to improve their access to health services?
Arafat: In Uganda, youth make up around 75% of the population and so the disparities in health services are disproportionately felt by its young people. Earlier this year, the Uganda Demographic Health survey revealed there was still a long way to go when it comes to adolescent health services. One of the more concerning findings in the survey was the slow or no progress in reducing teenage pregnancy rates (which stood at 24% in 2011, 25% in 2016 and 24% in 2022), this is partly due to underfunding for adolescent health programs, restricting policies to contraceptives for adolescents and lack of health services that respond to the needs of young people in most of the health facilities.
In response, I have been engaging with the Ministry of Health on prioritising adolescents and young people but I am concerned when I look at the resources allocated to adolescent health. In Uganda’s sharpened plan, which guides how the country invests in reproductive health and health for women and adolescents, only 3% of the budget that is allocated to reproductive health is to adolescent and school health. Without any substantial financial commitments, the Ministry of Health’s statements that it is prioritising young people’s health outcomes is all just talk. This is the reason why young people should take up space to hold decision-makers accountable to fulfil their commitments, as with so little financial resources there can be no change for young people.
Could you describe your work in Uganda and the different organisations you work with?
Arafat: I am a social worker by profession but alongside a colleague in Cote D’Ivoire, I also co-chair the Global Youth Platform, which is part of the Global Financing Facility (GFF). I am also chair of the Adolescent Health Forum, which is part of a wider coalition of civil society organisations that engage and hold the Uganda Government accountable on reproductive, maternal, newborn, child and adolescent health.
I also act as a Programme Manager for Naguru Youth Health Network (NYHN), which is a youth-led organisation supporting adolescent service delivery, advocacy, behaviour change and communication. For example, in Uganda there are District Committees on Adolescent Health, which are charged with monitoring and coordinating adolescent health programmes within particular districts. According to Ministry of Health guidelines, all district committees on adolescent health must have at least 2-4 youth representatives. However, the Naguru Youth Health Network found that these youth representatives did not have the advocacy capacity to represent youth issues. In response, the network mapped out ten districts in Uganda and worked with two youth representatives in each to build their capacity. The network is hoping to expand this work to other districts in Uganda when resources allow.
Could you explain a bit more about your role as co-chair of the Global Youth Platform as well how the Global Financing Facility (GFF) works in Uganda?
Arafat: In 2021, I was elected co-chair of the Global Youth Platform alongside my colleague Kenneth from ASAPSU, Cote d’Ivoire. Our priorities include strengthening the capacity of our members from other GFF countries to engage in advocacy at country and global level, joint resource mobilisation to enable members to sustain their interventions, and to strengthen spaces for knowledge sharing, exchange, and learning. All these are informed by an analysis that was conducted in 2021 to understand how youth are coordinated and engaging in country GFF processes.
The benefits of GFF financing and its targeted approach to health outcomes for women, children and adolescents are evident through the recent 2022 Uganda Demographic Health survey findings, which indicated a significant increase in the number of mothers that gave birth in hospitals, which increased from 80% in 2016 to 91% in 2022. This has led to a reduction in maternal mortality from 336 out of 100,000 live births to 189. Improvements in maternal care in Uganda can be attributed to GFF support that has facilitated upgrading health facilities, construction of new health facilities and procurement of health equipment. Furthermore, the GFF’s results-based financing model has worked to incentivise health workers and monitor the number of mothers they attend to, which has increased the number of mothers receiving ante-natal support.
What do you see as the main barriers to youth participation and engagement when it comes to advocating for improved access to health services?
Arafat: The biggest challenges facing youth organisations currently can be divided into three major areas. The first is around their capacity to meaningfully advocate. Many youth organisations have not been around for many years and do not have the capacity to meaningfully engage decision makers at high levels compared to more well-established organisations.
Another major challenge is around the limited resources to engage and sustain advocacy interventions. Advocacy at both global and national levels require financial backing and many youth organisations are unable to sustain interventions beyond a year due to single year small grant funding mechanisms. It is therefore critical for donors to consider multi-year funding mechanisms for youth organisations.
Lastly, many of the available funding opportunities do not focus on strengthening youth organisations themselves so that they can build strong systems aimed at improving leadership, financial management systems, innovative program design, documentation and sharing of high impact interventions. Without strong systems, youth organisations have faced challenges attracting large grants from agencies like the Global Fund that emphasise strong systems. The GFF and other partners should therefore be deliberate on strengthening the institutional capacity of youth organisations to enable them to attract other partners and sustain their interventions.
Many thanks to Arafat for speaking to us!