Reaching the unreached adolescents: A case Promoting Safer Choices for Adolescent project, Uganda

Promoting Safer Choices for Adolescents (ProSCAd) was a three-year innovative project (2004-2007) implemented in three districts of Uganda. The project aimed at building a body of evidence showing that addressing underlying causes of poor Sexual Reproductive Health (SRH) could achieve sustainable, lasting positive SRH changes. The goal was to reduce inequalities in SRH among adolescents (10-24 years). The project strategy was to bring various SRH stakeholders together to jointly explore and challenge the reasons for differences between adolescents SRH and to plan to improve the support systems for vulnerable adolescents.

ProSCAd targeted vulnerable/unreached adolescents (the self-excluded, sexually abused/exploited and neglected) – e.g., boda-boda (bicycle, motorbike) cyclists, pregnant adolescents, adolescent mothers and commercial sex workers.

Key outcomes: Out of 14,799 adolescents reached, 1371 (972 females, 399 males) were unreached adolescents. ProSCAd stimulated and supported behavior changes leading to increased utilization of antenatal, delivery services and family planning to 64.3%; decreased proportion of adolescent pregnancy to 30%; improved care of self and their children, re-built self-esteem, trust as well as income management and community care. Twelve mutual support groups were formed, associated with improved quality of health care services and increased reconciliation between adolescents and parents. This led to national advocacy that informed amendment of the law on defilement under the Penal Code.

Challenges included: short time frame (3 years), conceptual model and identifying target groups, leading to strong expectations among partners.

In conclusion, ProSCAd project developed and demonstrated many exciting adolescent SRH innovations, and achieved considerable positive behavioral changes and supportive nets in highly affected unreached adolescents and institutions.