The statistics are stark: By the time they are 18, most girls in Malawi already have three children. The country’s fertility rates are among the highest in the region – now even higher than those in neighbouring Mozambique, which suffered fifteen catastrophic years of bitter civil war. “For us it is like a war-torn country, seeing children as young as 11 going into child-bearing,” says Victoria Lonje, a GIZ technical officer working on sexual reproductive health and rights in Malawi.
Almost half of Malawi’s population is under 15 and although the country has made great progress in bringing down new HIV infection rates – by 70 percent between 2005 (93,000) and 2013 (28,000) - the national prevalence rate remains stubbornly high (10.3 percent in 2014). Very high rates of teenage pregnancy and school dropout due to early marriage mean that young girls are particularly at risk from HIV and other sexually transmitted infections. In addition, the majority of maternal or neonatal deaths or problems of low birth weights occur in mothers under 22.
Victoria Lonje says the sexual reproductive health and rights’ needs of adolescents in Malawi have often been woefully overlooked or inadequately addressed.
Narrowing the gap
To address this gap, the Malawi German Health Programme, in collaboration with UNICEF, Banja La Mtsogolo, Baylor College of Medicine Children’s Foundation and Pakachere Social Media, are working together to improve the information and services available to adolescents on sexual and reproductive health and HIV prevention.
Unusual for a bilateral development partnership, the German government decided to channel its financial and technical support for this project through UNICEF rather than the Ministry of Health, recognising that UNICEF would bring youth sensitive expertise to the project.
Working within and supporting the Ministry of Health’s strategic plan, the BMZ-UNICEF partnership on adolescent reproductive health has three main objectives:
To ensure that at least 80 percent of the youth in target districts receive correct information on HIV prevention, teenage pregnancy and sexual reproductive rights, so that they can protect themselves and have relevant skills to reduce their risks and vulnerability to HIV prevention by Sept 2016.
To reach 80 percent of vulnerable adolescents in those districts – those who are already sexually active – to prevent them from getting HIV or STIs and ensure they have access to testing and counselling provided through mobile Banja La Mtsogolo and other local services.
To ensure that 80 percent of adolescents living with HIV are able to access quality care, treatment and support through the Baylor clinic, which works with 10 to 19 year olds, or through local health facilities
How will these objectives be achieved?
On behalf of BMZ, GIZ’s role is to provide technical support, and Victoria Lonje works with a team which includes specialists in child protection, a nurse for youth friendly services and community outreach counsellors who address cultural barriers. She has regular co-ordination meetings with her counterparts in UNICEF and the Ministry of Health and district level and every six months travels with her team to provide technical support to the 10 districts and district health offices.
Vans with music, “edutainment” and lively social media campaigns prepare the way for the outreach teams going to the districts, so that young people are mobilised to attend mobile HIV testing and counselling.
Radio and TV campaigns also raise awareness of the issues, and a Help Line has been set up so that adolescents can pick up a phone any time of the day and ask a question or present a problem.
Where these calls reveal sexual abuse has taken place, the YONECO child helpline staff links with the victim support unit, which is managed by community police. The Victims Support Unit is supposed to follow up and address the child protection issues but often falls short of doing so due to various limitations, capacity challenges being prominent.
What has been done so far?
Twenty one Teen Clubs which meet monthly have been established in 10 districts;
More than 1,100 young Malawians living with HIV have joined these Teen Clubs;
7,754 adolescents received family planning services;
33,000 young people 10-19 years received HIV testing and counselling;
1,479 adolescents received treatment for sexually transmitted infections, and 136,559 received condoms.
The project is only just over half way through, and although much has been achieved, many challenges of course remain. Available district based data remains inconsistent and unreliable, and financial weaknesses and issues of accountability have hindered progress in some areas. Rapid staff turnover of health professionals trained in youth friendly service delivery lowers the quality of services, and a recent government directive reducing official allowances, means that fewer officials turn up for meetings.
The biggest challenge of all, says Victoria Lonje is sustainability. “We saw that in the four districts where we didn’t go in with the resources, hardly anything was moving, so we were asking ourselves what will happen two years down the road when GIZ resources are not there? Is this thing going to have lasting impact?”