How does a country improve HIV and sexual and reproductive health progress for adolescents? We may think it is tech innovation or new celebrity voices or novel social media. But in fact, it is much simpler. Analysis and planning will 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. Why was that the case? How could it change? The challenge was to find out.
In response to these questions, UNICEF and UNAIDS launched All In to End Adolescent AIDS (All In), a global platform which uses evidence to support 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 aspects of national AIDS programmes through better data collection and analysis. It will also engage policymakers to refine national strategies for priority HIV services, as well as access to information for adolescents through partnerships and wide-ranging 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, Rwanda’s government and partners conducted an assessment of HIV and sexual and reproductive health (SRH) trends and information gaps related to adolescents. The results were alarming – they indicated three things: new adolescent HIV infections were increasing, a substantial portion of adolescents are married before age 18 and adolescent pregnancy rates are rising.
A clear reason stood out to explain these findings: little knowledge and use of SRH services – including HIV services – by adolescents. The assessment showed gaps in some key interventions: condoms to prevent pregnancy and HIV infection, general family planning, voluntary male circumcision, HIV testing, and treatment.
The next step brought together Rwanda’s brightest minds to outline a clear plan for addressing these problems. The result, National Operational Plan for HIV and Sexual and Reproductive Health among Adolescents and Young Adults 2017 – 2020, creates clear targets and signs to scale up 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.” The process included members of adolescent and youth networks since another key tenet of All In is increasing adolescent participation. When adolescents help shape policies from the start, they take greater ownership of the results.
The resulting Operational Plan accounts for bottlenecks that prevent optimal service coverage. This includes issues such as drug supplies and mapping the number of trained healthcare workers across districts.
The Operational Plan breaks down interventions by age, so younger adolescents are addressed differently than older adolescents. And it includes targets for all interventions, key to tracking implementation progress.
The All In assessment and ensuing Operational Plan 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 also helped allocate domestic and donor funds (such as 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 and partners will oversee 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?
Sunita Bains is Regional Adviser on HIV/AIDS in the UNICEF East Africa office
Alice Armstrong is a Communications Consultant on HIV/AIDS in the UNICEF East Africa office