Adding Value with Inclusive Development: Involving Adolescents in Strategic Planning to Improve Health Systems

By: Emilia Eyo Okon, Gender, Social Inclusion, & Community Engagement Advisor, WI-HER

On the USAID Integrated Health Program (IHP) in Nigeria, led by Palladium, WI-HER prioritizes the inclusion of beneficiaries in its efforts to support the state to strengthen the health system and improve access to and quality of health services. As such, during the development of the Ebonyi State Strategy for Gender in Health, WI-HER’s Gender, Social Inclusion, and Community Engagement (GSI&CE) Advisor Emilia Eyo Okon advocated to invite beneficiaries of the health system to the Gender Desk Review Dissemination and Strategy Development Workshop and other planning meetings so their voices could be heard. Several beneficiaries were able to attend, including adolescents and youth. Emilia Okon held a short interview with Chukwu Onyinyechi, one of the adolescents who attended the strategy development workshop, to talk about herself, her experience during the meeting, and how this has impacted her life.

Emilia Okon (E.O.): Tell us about yourself.

Chukwu Onyinyechi: My name is Chukwu Onyinyechi. I am 19 years from Ohoazara Local Government Area (LGA) in Ebonyi State. I am currently a student studying English and Literature in the Ebonyi State University. I also volunteer my time as a gender desk officer for an organization called Health for the Society Justice and Peace Initiative. I am a young mother who had a child as a teenager.

E.O.: What are some key issues affecting adolescents in Ebonyi State?

 Ms. Onyinyechi: There are several:

• Teenage Pregnancy: Teenage pregnancy is very high in Ebonyi State. Young girls do not have access to correct information about how to prevent pregnancy. Poverty is the underlying factor contributing to teenage pregnancy, but it is made worse by the fact that young girls have no information about contraceptives or any other pregnancy preventive measures. Most parents do not talk to their daughters about preventing pregnancy. Most families do not talk about sexual intercourse as they find it uncomfortable to discuss. I usually use my spare time to talk to young girls about preventing pregnancy so they can finish school; I give them information about how they can access contraceptives at the health facilities or abstain from sex until they are ready. I usually use my personal experience as an example. Many of them experience shame when talking to health workers, but I encourage them to visit health facilities because it is better to ask for assistance even when they feel uncomfortable. Health workers are usually judgmental when young girls come to the facility to get contraceptives. I think the health workers should be polite and friendly to young girls when they come to the health facility; if not these girls are likely not to come back. I encourage non-governmental organizations (NGOs) and programs like IHP to find ways to go to schools to train adolescents on how to live healthy lives.
• Child Trafficking and Transactional Sex: There is a lot of child trafficking and child labor in Ebonyi State. Many children hawk, or sell things on the streets as a way to earn money for their families, but this exposes young girls to risk of sexual abuse by older men, including child trafficking and transactional sex. Cases like this are usually not reported because young girls find it difficult to confide in anyone – and this can lead to a cycle of abuse. It disturbs them mentally. Sexual abuse can become an unavoidable part of a growing young girl’s life in my state.
• Low number of girls in school: Most young girls are not in school because their education is not seen as important. Many parents do not value education for their daughters.

E.O.: Why do you think it is important to involve adolescents (and other direct beneficiaries) in planning to improve health?

Ms. Onyinyechi: Because adolescents should be there to speak for themselves and share their experiences. It also gives adolescents an opportunity to learn new ideas and meet people, so they know who to contact when they face difficulties. We need role models and people we can trust; it is in such meetings that these kinds of connections can form. It also provides an opportunity for adolescents to get correct information about health issues.

E.O.: How did attending the Gender Desk Review Dissemination and Strategy Development Workshop affect your ability to contribute to interventions that affect adolescents?

Ms. Onyinyechi: I was able to learn about how gender strategies are developed. I felt important, because my ideas were included in the adolescent section of the gender strategy. I learned new information that I will be using in my work. The information about different youth-friendly health centers in Ebonyi State will be especially helpful. I will be referring other adolescents to those centers.

E.O.: How did it feel to be included in a planning meeting like this? Did you learn anything during the process?

Ms. Onyinyechi: I felt important and valued, like my voice was finally heard. At first when I came for the meeting I was discouraged, but after the first day, I knew it was a valuable meeting that I needed to be part of. I learnt and contributed a lot during the process. I think adolescents should be included in planning so we can express our minds and be included in decisions that are made.

I learnt there are some adolescent friendly facilities in my state, and I have taken note of them. I also learnt about the importance of involving persons with disabilities in health interventions. I contributed into the strategy by highlighting ways adolescent can accept suggestions from health workers. I learned there are approaches to improve infrastructures in health facilities that will make them friendlier for adolescents. I also hope next time we can have male adolescents as participants in such meetings.

E.O.: What kind of perspectives did you express to other attendees during the meeting?

Ms. Onyinyechi: I brought up the issues and barriers that make it difficult for adolescents to access information at the health facility. I brought to the forefront that there are no sexuality education counselors in the schools that should be there. I also mentioned the fact that most people are very religious, which shapes the sexuality education that young people receive, but I emphasized that young people still need facts. Health workers should be trained to be more friendly while listening and attending to the needs of young people. Most health workers have attitudes that send young people away and discourage them from ever coming back. The health workers should be patient, should not threaten youth, and should not break confidentiality. Additionally, health workers should be taught not to impose their ideas and beliefs on young people who visit health facilities.  I also suggested finding ways to educate parents to help them become more open to allowing their children to access good information on adolescent health.

E.O.: After the session, is there anything you would hope to see done differently in the health system or facilities? Is there anything you would want to do differently?

Ms. Onyinyechi: I would like to see health workers become more friendly to youth and adolescents. I do not want health workers to threaten us that they will tell our parents if we come for contraceptives. I would also like to see the government abolish street hawking (street selling) in the state because it is one of the easiest avenues for sexual abuse. I would love to see health workers not discriminate against pregnant adolescents so we can assist young women who become mothers to reintegrate and be supported in society. That is part of my story and I will continue using it to inspire young women and encourage change.