How does a country accelerate better HIV and sexual and reproductive health programming for adolescents? We may be drawn to think it is technological innovation or new ways of engagement through celebrities and social media. But in fact, it is much simpler. With proper analysis and planning we can undoubtedly accelerate progress for adolescent health.
Although Rwanda has high coverage of HIV services, the government was aware that programs were not adequately reaching adolescents aged 10-19 years. The challenge is that they lacked a thorough understanding of why that was the case and how coverage could be improved.
In response to these challenges UNICEF and UNAIDS launched All In to end Adolescent AIDS (All In), a global platform which aims to promote the use of evidence to support development of more effective strategies, policies, programmes and services for adolescents living with and affected by HIV. A key focus of All in is to sharpen adolescent elements of national AIDS programmes through improved data collection and analysis and engagement of policy makers to refine national strategies for priority HIV services and access to information for adolescents through strategic partner engagement and cross-sectoral linkages.
“All In was a call to action,” said Fabian Mwanyumba of UNICEF Rwanda. “Much as adolescents were being talked about in the country, there was not a clear, structured way of looking at their needs.”
Through All In, the government of Rwanda and partners conducted a rapid assessment to better understand HIV and sexual and reproductive health trends and programme gaps related to adolescents. The results were alarming, indicating that new HIV infections among adolescents were increasing, a substantial proportion of adolescents are married before age 18 and adolescent pregnancy rates are on the rise.
A clear reason stood out to explain these findings: low knowledge and utilization of sexual and reproductive health services, including HIV services, by adolescents. The assessment identified coverage gaps in key interventions including condoms to prevent pregnancy and HIV infection; family planning; voluntary medical male circumcision; HIV testing; and HIV treatment. Programming was often done in silos, with little collaboration within and across different ministries, agencies and providers responsible for adolescent health.
The next step brought together Rwanda’s brightest minds to outline a clear plan for addressing these gaps. The result, the National Operational Plan for HIV and Sexual and Reproductive Health Among Adolescents and Young Adults 2017 - 2020, creates clear targets and indicators for scaling up the HIV response for adolescents across Rwanda.
“This plan is unique for Rwanda because we went in deep to analyze the reasons behind the service coverage gap,” said Dr Mpundu Ribakare, from the Rwanda Biomedical Centre, an arm of the Ministry of Health. “We also created the plan through a participatory process.” This process included representatives of adolescent and youth networks, since another key tenet of All In is improving meaningful adolescent participation. When adolescents are involved from the beginning in shaping policies, they have greater ownership of the results.
The resulting Operational Plan takes into account programmatic challenges, often referred to as bottlenecks that prevent optimal service coverage. This includes issues such as drug supply levels and whether there are enough trained health care workers in different districts.
The Operational Plan breaks down appropriate interventions by age, so that the needs of younger adolescents can be addressed differently from those of older adolescents. And it includes targets for all interventions, key to tracking implementation progress.
The All In assessment and ensuing Operational Plan have now influenced implementation of the country’s National HIV Strategic Plan, helping to get everyone on the same page about adolescent HIV and SRH. The Plan has also helped allocate domestic and donor funds such as from the Global Fund appropriately, and served as a blueprint for fundraising efforts and partner coordination by the government.
In the next few months, partners at the district level will start adopting the Operational Plan for their local contexts. In Rwanda’s capital Kigali, city officials, along with relevant government colleagues will take the lead in overseeing the Plan’s implementation and ensure all adolescents gain access to the information and services they need. As new data emerge, the Plan will be continually updated to ensure it works for adolescents.
Now that Rwanda is going “all in” for adolescent health, will other countries follow suit?
Rwanda’s operational plan for adolescent HIV and sexual and reproductive health