Young girls and women forum

Mauritius forms part of the middle income countries according to World Bank. The country has made major leaps in the economic sector and tops several development goals in Sub Saharan Africa. While several sectors have progressed significantly, the health sector, especially primary care area needs attention and investment to meet the evolving healthcare needs of the population.

The Ministry of Health and Wellness has as mission to improve quality of care in all the areas of health through dedicated efforts. The World Health Organisation, Mauritius is keen to support the strategic planning to promote the essence of quality care in the sector. However, at present indicators are recorded through health statistics survey or targeted research such as the NCD survey. A systematic capture of indicators, especially in the domain of adolescent health is deficient that will provide real-time information that can be used for predictive modelling to guide health resource utilisation.

Adolescent health is presenting a challenging concern for public health, especially following the Covid pandemic. The rate of mental health problems among adolescents have escalated. While adolescents are considered an important group in the population, this group is however less presented in the health sector in several countries especially at the primary care level.

Adolescence spans from the age to 10-19 years. It is referred to the age of transition, where the health needs including psychosocial needs evolve and present a challenge for parents and health professionals. The World Health Organisation estimates adolescents account for 16% of the world population with 1.3 billion adolescents. UNICEF reports that the needs of adolescents are different from that of children, and although their rights are taken care under the convention of the right of the child, their needs remain un-addressed.It is indeed distressing to note that in 2019 around 5000 adolescents and young adults died. While the lowest risk remains in the 10-14 age group, the risk escalates as the age progresses. A number of the causes of death have been shown to be preventable such as injuries, and death related to maternal complications. The highest contributors of death include injuries incurred during road traffic accidents, violence include bullying, and suicide.

The rising morbidity related to communicable and non-communicable diseases cannot be undermined especially in low and middle income countries. Sub-Saharan Africa reports highest rates of disease burden in adolescents globally. While poverty, globalisation and evolving lifestyle habits are predominant factors, country specific factors such as cultures, health systems and legislation have important roles in addressing the health needs of adolescents and young people. Several issues have been prioritised by the WHO including substance misuse such as alcohol, tobacco, drugs, teenage pregnancy, mental health problems, HIV, lack of physical activity, malnutrition, thus increasing the risk of non-communicable diseases. The alarming rates of health concerns call for urgent action required to enhance accessibility to the health system in an adolescent friendly way.

Mauritius is situated on the East coast of Africa and bears a population of 1.3 million people. The last few decades the country has made leaps in the area of financial development shifting its place in the upper middle income range. As the country continues to progress economically, the health sector and the health system is striving to reflect the country development pace, through the strengthening of the curative strategies. Secondary care hospitals, specialist centers are built with modern infrastructure to expedite rapid diagnosis and early treatment measures. However, the preventative efforts remain weak reducing the leverage on the health system. The primary care system consists a number of health centers spread geographically around the country to provide essential services to the general population. Several medical services including preventive services are offered to patients seeking services from the health centers. It has been however observed that adolescent health services are scarce at the center and not oriented to accommodate the specific needs of this age group, which leads to loss of important information on indicators.

It can be appreciated the burden of disease among adolescents is small but not negligible, and has implicated for future health burden. It is thus crucial that indicators are identified and reported in a formal and informal approach. Browsing through the public domains, a scarcity of information available to adolescents have been observed in the countries arena. Infrastructure and the current health system model enable patient centered approach difficult among adolescents, leaving this population group unaccounted for. While adolescents contribute minimally to global disease burden, they represent future health burden. To slow the accent of future health burden, it is logical to intervene with adolescent health at the present time, in the hope to improve future health. Hence, accessing adolescents details and needs is the stepping stone in shaping an adolescent friendly health care.

Mauritius current strategy to access information on adolescent health relies on school surveys. The Mauritius school survey uses the global school survey and was last implemented as part of the NCD survey in 2017. A series of questions related to the behaviors including diet, physical activity, smoking, drinking, bullying, suicidal tendencies, weight etc were used to collect information. The survey is crucial in guiding policy making processes, but the anonymity and tracking of information to reach the specific groups limits the application of the survey tool for patient centered indicators. The global health survey further does not fully explore the sexual health and reproductive needs of the population.

Sexual health and reproductive needs of adolescents form part of the general policy document published in 2007, where the emphasis was on sexual education to promote healthy sexual practices. One of the key priorities of the policy was to ensure that reproductive and sexual health is made accessible to all including adolescents. However, one of the barriers faced by adolescents is that availability of centers that can provide sexual health information and contraception to adolescents in the absence of parents. The current legislation supports the care accessible to adolescents but only when accompanied by guardians or parents, which makes it difficult for adolescents to access the services. This in turn impacts information on indicators, as adolescents do not feel confident to attend primary health care services, jeopardizing their own health and abiding to unhealthy sexual practices, culminating into high rates of unwanted pregnancies. Teenage pregnancy remains an important social problem that has not been resolved with current policies and strategies.

Hence, we propose an innovative approach to gather data on sexual health needs among teenagers, especially among teenage girls in the primary health care settings. The following steps are proposed:

Develop a girls and young women forum for exchange of health related information, providing support and network to those adolescents in need. The forum will run on blended mode, with face to face contacts and contacts through social media.

The aim of this forum will be to identify and explore health issues among young women facilitating a brainstorming process developing ideas and initiatives that can be translated into practice.

• Improving knowledge on the needs of adolescents per region by linking the forum to schools and primary care centers.
• The system will alert the community physician on the needs and facilitate planning of services
• Schools will identify educational needs related to health
• The physician in charge might invite the adolescent and the parents to seek health services and contribute to the forum, through social media such as instagram/facebook or other similar platforms
• The platforms will also be used to access information on needs and promote access in primary care to adolescents. The platform will connect with with health information system and feed in regular information to the primary care doctors, who will in turn identify pathways to meet the demands of the adolescents in a confidential way.

Methodology

Development of forum

An invitation will be sent to schools and communities where there girls and young women. They will be encourage to get enrolled in the programme and can establish and maintain contact through social media or other forms of communication. A leading team will be identified in charge of coordinating communications and meetings, collecting information from social media platform and transmitting these data to the relevant stakeholders (Health or education).

Linking of information

DHIS2 is a free software that is being advocated by WHO and can be used to link data from the forum to health information system used by the primary care centers.   

Piloting health checks for 13 year olds (in 1 catchment area)

Through the forum, participants will be invited to attend a 13 year consultation will be mandatory and use to

• Establish rapport and continuity of care with the adolescent
• Provide contact and support, explore sexual and reproductive health needs and concerns
• Use of social media to pull information about health will be encouraged
• Yearly STI screening and discussion on contraception in an adolescent friendly way (dropping to urine sample)

Primary care physicians will be purposely trained to conduct a patient-centred screening consultation, as well as collection information that will enhance capture of indicators.

It has been reported that low and middle income countries have weak capacity to meet the sexual and reproductive needs of the new generation teenagers. Hence, the consultations will be used as a tool to document the needs of teenagers as well as providing support and information as well as resources to ensure safe sexual behaviours.

 Expected outcomes

It is anticipated that by the end of the project:

• A system of digital forum will have been designed and implemented, which will help capture key indicators regarding adolescents girls and young women and match resources to their needs;
• Primary care physicians in the catchment areas will have received education and training in dealing with adolescents including sexual health and mental health; use of forum for data migration; recording and analysing information relevant to their catchment area;
• Developed and implemented a tool to assess the needs of adolescents and use this tool to assess and prioritise the needs of the given population, and help with data collection;
• Analysis of captured data to evaluate the system;
• Conduct a stakeholder engagement and analysis to negotiate large scale implementation of the system

The solution serve adolescents and young women, who are at high risk of developing sexually transmitted diseases such as HIV and teenage pregnancy. This group remains vulnerable and contributors of communicable diseases burden. Although the MDG and SDG have led to improvement in indicators related to maternal and child health, no change has been observed in this group.

The proposed solution will enhance communication between this group and healthcare providers to optimise resource identification and allocation for tailored services that can help shift the figures.

The World Health Organisation Office Mauritius partners with the Ministry of Health and Wellness to facilitate implementation of the project. The MoHW has several experienced health professionals who can provide their input during the implementation phase.

This project has a strong community engagement bring the voice of an underserved population to policy makers.

At present services at the primary care level are not tailored to the youth and adolescents due to current legal and cultural factors adding to the financial prioritisation. The challenge will importantly help with financial support to push in projects that can be financially challenging. Hence, in other nations with similar issues having the resource can facilitate project implementation provide data related to indicators.

The solution is innovative as there are no current similar solutions in the country. It further applies a participatory approach through a modality that translates the youth problems and ideas into data for processing and policy decision making process as the communications will be analysed and transformed into data.

We develop projects to help the Ministry of Health enhance the health services.

We intent to pilot the project and transfer the responsibilities to the MoH to further invest and sustain the project as well as upscale the project.