Basotho youth get a say in improving healthcare services

Lesotho is well known for its beautiful, majestic mountains. It has a population of just 2.2 million people, many of whom live in rural villages, dotted on the slopes of the rolling hills. Lesotho also has the second highest HIV prevalence rate in the world. Most of those infected and affected are adolescents. Girls and young women are particularly at risk, with female prevalence sitting at 29.7 per cent. Compounding the problem is early marriage, a relatively low level of awareness about what could lead to HIV infection, and low numbers of adolescents attending health centres. Ensuring that young people visit the clinics, and have access to reliable healthcare advice, is a huge priority for the Lesotho government and the joint UN Together for Sexual and Reproductive Health and Rights Programme.

One of the biggest complaints from adolescents is about the treatment they receive at health centres. Many say they don’t get the impression that they are free to ask questions about their sexual health.

The Government of Lesotho, along with UNICEF and other partners, has introduced an innovative project, which gives young people an opportunity to shape the healthcare services they receive. It entails young people visiting healthcare facilities and rating the services they receive – using a detailed scorecard.

“We often hear when young people, particularly girls, go to healthcare centres looking for contraception or HIV information, or perhaps they’re pregnant, and they don’t receive a warm welcome from the nurses. Some say they get judgemental responses, or they’re told to go home. It might even be a relative who’s working in the healthcare facility in a remote area. I think we must put that in context. One is, we have healthcare providers who are really overworked, working long hours and have to respond to a whole range of issues, and the other is that maybe they haven’t been engaged enough in terms of what adolescents need and what young people need, how they would define good quality service in a healthcare facility,” said Anurita Bains, the UNICEF Representative in Lesotho.

In a bid to improve the experience young people receive at hospitals and clinics, the Government of Lesotho developed the Minimum Standards and Implementation Guide for adolescent health friendly services. Mathato Nkuatsana, the Adolescent Health Programme Manager at the Ministry of Health, says the youth scorecards are one way of ensuring that the minimum standards are met. The scorecards are quite detailed – they ask, among other questions, if the healthcare centres have youth corners or spaces for confidential chats, if staff are readily available or if young people have to wait a long time for service, if healthcare professionals were properly trained to deal with issues and if adolescents are given free basic sexual and reproductive health services. 

“I think this is working very well, and it also helps us with the uptake of services by young people, because these young people mobilise their peers to come to the services. So the issues of comprehensive sexual and reproductive education now will be enhanced. And service providers’ attitudes towards clients has changed a lot because now they can have time, sit together and discuss. And it’s good because it’s not like they are judging each other, they discuss issues and come to an agreement on how best can they deliver services to young people.”

Twenty-four-year-old Malitsietsi Malepa lives in the rural Berea region of Lesotho. She participates in the Let Youth Lead initiative by talking to peers about their experiences, going to health centres, rating the services and sitting in meetings with nurses to relay the information.

“There are things that concern us as young people, I think. So, we shouldn’t allow people to take decisions on our behalf when we can still talk. They don’t know our needs, we do, so we should tell them what we need, what we want, what should be changed,” says Malitsietsi.

The project is implemented in communities by NGOs, Sentebale and Skillshare. They work closely with adolescents to ensure they receive the support they need, while carrying out this important work.

“The Let Youth Lead initiative, funded by UNICEF, it’s specifically meant to capacitate young people and healthcare workers to monitor adolescent friendly health services, using social accountability as an approach to the project. We believe that the healthcare workers are providing services to these young people, but they never get time to get feedback as to how these people view the services, how they perceive the services. The services are a product and they need to know how the customers view the product,” said Lipolelo Monaheng, who works for Sentabale, as a Youth Lead coordinator.

Nurses say they are already seeing a positive change, after implementing some of the suggestions the young people have raised. Some clinics have extended their hours to accommodate adolescents after school, or those who work till late in the fields, herding cattle. Patient confidentiality is also being respected.

“Since we, we decided to see the adolescents separately from the other patients, they’ve become very open. We group them together as adolescents and give them health talks and they are free to ask any questions. Now they are not afraid that a father or mother from their village will ask, ‘hey wena, you’re having sex at your age?’ So they feel free to discuss everything,” said Maseeiso Lerotholi, a nurse from Mohlanapeng Health Centre in Thaba Tseka.

Young people involved with the project now feel more empowered to approach clinics, as they are aware of what their rights are, in a healthcare setting.

** The Let Youth Lead programme was made possible by the Government of Lesotho and the joint UN Together for Sexual and Reproductive Health and Rights Programme, with funding from the Swedish government.