Health facility capacities for providing adolescent sexual and reproductive health services in Southwestern Uganda

Abstract

Background: Provision of adolescent-friendly Health services (AFHS) at lower primary health care centres (PHCs) is a core strategy for improving access and health outcomes of adolescents. In this study we assessed the health facility-based prevalence of repeat adolescent pregnancies and the capacity of PHCs (Health centres (HC) level III and IV) to provide AFHS in Uganda. Methods: We conducted a cross-sectional study between April and May 2023 involving 43 healthcare facilities (33 HC III and 10 HC IV) across 4 districts in Southwestern Uganda. Using pretested structured questionnaires, we interviewed the health facility in-charges or their delegates. We extracted the 6-month information from registers on: number of repeat adolescent pregnancies, post-abortion, and post-natal adolescents attending each facility. With a checklist, we assessed the availability of family planning materials/services and other medical equipment. Descriptive statistics were generated. Results: Adolescent contributed 4.9%, 16.3% and 14.8% of all repeat pregnancy, post-abortion and postnatal consultations documented at all PHCs. We noted a low perinatal care staffing with the majority of HC IIIs lacking adolescent peer educators (n=34; 79%), and counsellors (n=26; 60.5%). The need for training in the provision of adolescent-friendly services, post-natal or post-abortion care in adolescents (>90%) was high. PHCs were inadequately supplied with equipment for post-abortion care and IUD insertion. Female and male sterilization and emergency contraception were less offered. Health workers were willing to give family planning to previously pregnant adolescents (90.7%), without parental consent (65.2%), but did not support contraceptive administration to adolescents who had formerly been pregnant in fear of promoting sexual promiscuity (41.9%). A quarter of the PHCs had a dedicated clinic for adolescents and had a day in the week for adolescent services. Conclusions: This study reveals major gaps in adolescent perinatal care in Southwestern Uganda, including limited peer educators, inadequate post-abortion care, and poor healthcare worker training. Strengthening services requires interactive, peer-based training and addressing staffing shortages through peer educators and community health workers. Equipping Health Centre IIIs to deliver comprehensive, adolescent-friendly care is essential to improving access and closing these critical service gaps