"Other risks don't stop": adapting a youth sexual and reproductive health intervention in Zimbabwe during COVID-19
- PMID: 35192449
- PMCID: PMC8865116
- DOI: 10.1080/26410397.2022.2029338
"Other risks don't stop": adapting a youth sexual and reproductive health intervention in Zimbabwe during COVID-19
Abstract
COVID-19 threatens hard-won gains in sexual and reproductive health (SRH) through compromising the ability of services to meet needs. Youth are particularly threatened due to existing barriers to their access to services. CHIEDZA is a community-based integrated SRH intervention for youth being trialled in Zimbabwe. CHIEDZA closed in March 2020, in response to national lockdown, and reopened in May 2020, categorised as an essential service. We aimed to understand the impact of CHIEDZA's closure and its reopening, with adaptations to reduce COVID-19 transmission, on provider and youth experiences. Qualitative methods included interviews with service providers (n = 22) and youth (n = 26), and observations of CHIEDZA sites (n = 10) and intervention team meetings (n = 7). Analysis was iterative and inductive. The sudden closure of CHIEDZA impeded youth access to SRH services. The reopening of CHIEDZA was welcomed, but the necessary adaptations impacted the intervention and engagement with it. Adaptations restricted time with healthcare providers, heightening the tension between numbers of youths accessing the service and quality of service provision. The removal of social activities, which had particularly appealed to young men, impacted youth engagement and access to services, particularly for males. This paper demonstrates how a community-based youth-centred SRH intervention has been affected by and adapted to COVID-19. We demonstrate how critical ongoing service provision is, but how adaptations negatively impact service provision and youth engagement. The impact of adaptations additionally emphasises how time with non-judgemental providers, social activities, and integrated services are core components of youth-friendly services, not added extras.
Le COVID-19 menace les progrès durement acquis dans la santé sexuelle et reproductive (SSR) car il compromet la capacité des services de répondre aux besoins. Les jeunes sont particulièrement à risque, du fait des obstacles contrariant leur accès aux services. CHIEDZA est une intervention communautaire intégrée de SSR pour les jeunes qui est en cours d’expérimentation au Zimbabwe. CHIEDZA a fermé en mars 2020, suite au confinement national, et a rouvert en mai 2020, en tant que service essentiel. Nous souhaitions comprendre l’impact de la fermeture de CHIEDZA et de sa réouverture, avec des adaptations pour réduire la transmission du COVID-19, sur les expériences des prestataires et des jeunes. Les méthodes qualitatives comprenaient des entretiens avec des prestataires de services (n = 22) et des jeunes (n = 26), ainsi que des observations des sites de CHIEDZA (n = 10) et des réunions avec les équipes d’intervention (n = 7). L’analyse a été itérative et inductive. La brusque fermeture de CHIEDZA a empêché les jeunes d’avoir accès aux services de SSR. La réouverture de CHIEDZA a été saluée, mais les adaptations requises ont eu des répercussions sur l’intervention et la participation au projet. Les adaptations ont restreint le temps passé avec les prestataires de soins de santé, ont accentué la tension entre le nombre de jeunes ayant accès aux services et la qualité des services. La suppression des activités sociales, qui plaisaient particulièrement aux jeunes hommes, a sapé la participation des jeunes et l’accès aux services, spécialement des garçons. Cet article décrit comment une intervention de SSR communautaire axée sur les jeunes a été touchée par le COVID-19 et s’est adaptée. Nous démontrons combien est importante la continuité de la prestation des services, mais comment les adaptations nuisent à la prestation des services et à la participation des jeunes. L’impact des adaptations souligne également comment les moments passés avec des prestataires non moralisateurs, les activités sociales et les services intégrés sont des éléments clés de services adaptés aux jeunes, et non de simples suppléments.
COVID-19 pone en peligro los avances obtenidos con tanto esfuerzo en el área de salud sexual y reproductiva (SSR) al comprometer la capacidad de los servicios para atender las necesidades de las personas. La juventud en particular se ve amenazada debido a las barreras que enfrenta para acceder a los servicios. CHIEDZA es una intervención de SSR integrada y comunitaria para jóvenes que está siendo puesta a prueba en Zimbabue. CHIEDZA cerró en marzo de 2020, en respuesta al cierre nacional, y volvió a abrir en mayo de 2020, categorizada como un servicio esencial. Nos propusimos entender el impacto del cierre de CHIEDZA y su reapertura, con adaptaciones para reducir la transmisión de COVID-19, en las experiencias de prestadores de servicios y jóvenes. Los métodos cualitativos utilizados fueron entrevistas con prestadores de servicios (n = 22) y jóvenes (n = 26), y observaciones de los sitios de CHIEDZA (n = 10) y reuniones del equipo de intervención (n = 7). El análisis fue iterativo e inductivo. El cierre repentino de CHIEDZA impidió el acceso de la juventud a los servicios de SSR. La reapertura de CHIEDZA fue bienvenida, pero las adaptaciones necesarias impactaron la intervención y la participación en ella. Las adaptaciones restringieron el tiempo con los prestadores de servicios de salud, lo cual aumentó la tensión entre la cantidad de jóvenes que accedían al servicio y la calidad de la prestación de servicios. La eliminación de actividades sociales, que habían atraído a los hombres jóvenes en particular, impactó la participación de la juventud y su acceso a los servicios, en particular para los hombres. Este artículo demuestra cómo una intervención de SSR comunitaria, centrada en jóvenes, ha sido afectada y adaptada por COVID-19. Demostramos que la continuación de la prestación de servicios es imperativa, pero que las adaptaciones impactan negativamente la prestación de servicios y la participación de jóvenes. El impacto de las adaptaciones también hace hincapié en que el tiempo con prestadores sin prejuicios, las actividades sociales y los servicios integrados son componentes fundamentales de los servicios amigables a jóvenes, y no extras innecesarios.
Keywords: COVID-19; HIV; Zimbabwe; sexual and reproductive health; young people; youth; youth-friendly.
Conflict of interest statement
No potential conflict of interest was reported by the author(s).
Figures
Similar articles
-
Family Planning Experiences and Needs of Young Women Living With and Without HIV Accessing an Integrated HIV and SRH Intervention in Zimbabwe-An Exploratory Qualitative Study.Front Glob Womens Health. 2022 May 19;3:781983. doi: 10.3389/fgwh.2022.781983. eCollection 2022. Front Glob Womens Health. 2022. PMID: 35663923 Free PMC article.
-
High uptake of menstrual health information, products and analgesics within an integrated sexual reproductive health service for young people in Zimbabwe.Reprod Health. 2024 Apr 22;21(1):56. doi: 10.1186/s12978-024-01789-y. Reprod Health. 2024. PMID: 38649934 Free PMC article.
-
Integration of a menstrual health intervention in a community-based sexual and reproductive health service for young people in Zimbabwe: a qualitative acceptability study.BMC Health Serv Res. 2022 Mar 30;22(1):421. doi: 10.1186/s12913-022-07818-5. BMC Health Serv Res. 2022. PMID: 35354445 Free PMC article.
-
Reproductive justice in the time of COVID-19: a systematic review of the indirect impacts of COVID-19 on sexual and reproductive health.Reprod Health. 2021 Dec 20;18(1):252. doi: 10.1186/s12978-021-01286-6. Reprod Health. 2021. PMID: 34930318 Free PMC article. Review.
-
Looking ahead in the COVID-19 pandemic: emerging lessons learned for sexual and reproductive health services in low- and middle-income countries.Reprod Health. 2021 Dec 14;18(1):248. doi: 10.1186/s12978-021-01307-4. Reprod Health. 2021. PMID: 34906177 Free PMC article. Review.
Cited by
-
Adapting to a global pandemic: a qualitative assessment of programmatic responses to COVID-19 in the multi-country Women's Integrated Sexual Health (WISH) programme.Sex Reprod Health Matters. 2023 Dec;31(1):2260174. doi: 10.1080/26410397.2023.2260174. Epub 2023 Oct 13. Sex Reprod Health Matters. 2023. PMID: 37830779 Free PMC article.
-
Interventions to maintain essential services for maternal, newborn, child, and adolescent health during the COVID-19 pandemic: A scoping review of evidence from low- and middle-income countries.J Glob Health. 2024 Jun 14;14:05024. doi: 10.7189/jogh.14.05024. J Glob Health. 2024. PMID: 38867685 Free PMC article.
-
Nimble adaptations to sexual and reproductive health service provision to adolescents and young people in the early phase of the COVID-19 pandemic.Sex Reprod Health Matters. 2024 Dec;32(1):2372165. doi: 10.1080/26410397.2024.2372165. Epub 2024 Jul 24. Sex Reprod Health Matters. 2024. PMID: 39046452 Free PMC article.
-
"I want one nurse who is friendly to talk to me properly like a friend": Learner preferences for HIV and contraceptive service provision in Gauteng, South Africa.Res Sq [Preprint]. 2023 Dec 12:rs.3.rs-3725260. doi: 10.21203/rs.3.rs-3725260/v1. Res Sq. 2023. PMID: 38168214 Free PMC article. Preprint.
-
The impact of community-based integrated HIV and sexual and reproductive health services for youth on population-level HIV viral load and sexually transmitted infections in Zimbabwe: protocol for the CHIEDZA cluster-randomised trial.Wellcome Open Res. 2023 Nov 7;7:54. doi: 10.12688/wellcomeopenres.17530.2. eCollection 2022. Wellcome Open Res. 2023. PMID: 38162283 Free PMC article.
References
-
- UNICEF . Reimagining a resilient HIV response for children, adolescents and pregnant women living with HIV. New York (NY: ): UNICEF; 2020 November 2020.
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Medical