AVAILABILITY AND ACCESSIBILITY OF REPRODUCTIVE HEALTH

CARE SERVICES AMONG THE YOUTH IN KAMUKUZI

DIVISION, MBARARA MUNICIPALITY: A CASE OF

KAMUKUZI HEALTH CENTRE III

BY

SHARIFAH NAKINTU

REG. NO. 17/BSU/BSWASA

A PROPOSAL SUBMITTED TO THE FACULTY OF BUSINESS, ECONOMICS

AND GOVERNANCE IN PARTIAL FULFILMENT OF THE REQUIREMENTS

FOR THE AWARD OF A BACHELORS DEGREE IN SOCIAL WORK

AND SOCIAL ADMINISTRATION OF BISHOP

STUART UNIVERSITY

APRIL, 2020

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 CHAPTER ONE

INTRODUCTION

1.0 Introduction

The study is about availability and accessibility of reproductive health care services among the
youth in Kamukuzi Division, Mbarara Municipality: A case of Kamukuzi Health Centre III. This
chapter presents the background, problem statement, objectives of the study, research questions,
scope of the study and significance of the study.

1.1 Background

Reproductive health care is defined as the constellation of methods, techniques, and services that
contribute to reproductive health and well-being by preventing and solving sexual health
problems (Roudi-Fahimi& Ashford, 2008).

The sexual and reproductive health needs of adolescents are often underserved in many societies,
yet adolescents constitute a large proportion of the population (Abajobir & Seme, 2014).
Globally, it is estimated that more than 220 million women in lower and middle income
countries (LMICs) have an unmet need for sexual reproductive health services (Singh &
Darroch, 2012). Overall, little progress has been made in increasing uptake of contraception. The
youth represent 25% of the world population and are characterized by series of physiological,
psychological and social changes that expose them to unhealthy sexual behaviour such as early
sex experimentation, unsafe sex and multiple sexual partners (Population Reference Bureau,
2013). These put them at high risk of reproductive health (RH) problems (Abajobir & Seme,
2014). Such problems include early marriage, teenage pregnancies, unsafe abortion, sexually
transmitted infections (STIs), HIV and AIDS, and other life threatening RH problems (Dida,
Darega & Takele, 2015).

Efforts to attain quality sexual and reproductive health are constrained by inadequate access to
and inequitable distribution of quality SRH services especially in sub-Sahara African countries.
These contribute to poor utilization of SRHS among young people in sub-Saharan African
countries (Obong’o and Zani, 2014) resulting to high prevalence of sexual and reproductive
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health problems especially among the adolescents (Global Health e-learning Center, 2014). An
estimate of 333 million new cases of curable STIs occur mostly in developing countries with the
highest rate among 20–24 years old, followed by those within the ages of 15 and 19 years (World
Health Organization, 2015).

Sub-Saharan Africa has a high level of HIV, with the 2015 Global Health Observatory data
suggesting that the region remains most severely affected, and has the highest adult HIV
prevalence (World Health Organisation, 2016). Compared with an average HIV prevalence of
0.8% among adults aged 15–49 years worldwide, nearly one in every 25 sub-Saharan African
adults (4.4%) live with HIV, and the region accounts for nearly 70% of the people living with
HIV worldwide (World Health Organisation, 2016). With an HIV prevalence of 4.4%, sub-
Saharan Africa compares unfavourably with South East Asia (0.3%), the Americas (0.5%),
Europe (0.4%), East Mediterranean (0.1%) and the Western Pacific (0.1%) (World Health
Organization, 2016). Similarly, other studies in sub-Saharan Africa have shown a high
prevalence of syphilis, gonorrhoea gonorrhea, bacterial vaginosis, trichomoniasis and herpes
simplex virus type 2 (Chico et al, 2012).

The high increase in the rate of these sexual reproductive health (SRH) problems among young
people in sub-Saharan Africa is alarming (Asante, 2013). This suggests the need for adequate
attention towards adolescents’ sexual and reproductive health. Adolescents’ SRH needs and
problems are yet to receive adequate attention especially in the developing countries like Nigeria,
despite the recognition of youth-friendly reproductive health services as a way of improving their
access and utilization of SRH services in order to achieve quality RH (Silva, 2015).

Efforts to attain quality sexual and reproductive health are constrained by inadequate access to
and inequitable distribution of quality SRH services especially in sub-Sahara African countries
(Obong’o & Zani, 2014). These contribute to poor utilization of RHS among young people in
sub-Saharan African countries, resulting to high prevalence of sexual and reproductive health
problems especially among the adolescents (Global Health e-learning Center, 2014). An estimate
of 333 million new cases of curable STIs occur mostly in developing countries with the highest
rate among 20–24 years old, followed by those within the ages of 15 and 19 years (World Health
Organization, 2015). It was also estimated that 1.3 million adolescent girls and 780,000

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adolescent boys were living with HIV worldwide, and 79% of new HIV infection among
adolescents were in Sub-Saharan Africa (Obong’o & Zani, 2014).

In sub Saharan Africa, only 10% of young men and 15% of young women were aware of their
HIV status (UNAIDS, 2014). Even when young people are able to access services, they may feel
embarrassed, face stigma on sexual matters, or have concerns about judgmental providers
(Santhya & Jejeebhoy, 2015). In Malawi, despite youth friendly health services (YFHS) being
established in 2007, the recent evaluation of the programme states only 31.7% of young people
have heard of YFHS in Malawi and 13% have ever used these services (MoH and E2A, 2014).
Likewise, comprehensive knowledge on HIV also remains low amongst young people, i.e., less
than half (42%) of young women and (45%) of young men ages 15 to 24 years fully understand
HIV and AIDS (MDHS, 2010). Young women are even less informed about condoms, with only
32% citing condom use as an effective prevention strategy as compared to over 42% of young
men (MDHS, 2010).

According to the Ethiopian Demographic and Health Survey (EDHS) of 2011, among the age
group of 15–24 years, HIV prevalence was 0.4%. That is, the utilization of family planning
services in the existing health care system by young people was also very low. As a result, there
is a high rate of unwanted pregnancies which often result in abortions and its complications.
From all posts, among incomplete abortion treatment seekers, the majority (67.2%) of them were
under 24 years of age. In addition, the 2011 EDHS figured out that contraceptive use among
adolescents were lower when compared with other age groups (Central Statistical Agency and
ICF International, 2012).

In Kenya, the National Reproductive Health Policy and Strategy, (Ministry of Health, 2009) and
the Adolescent Reproductive Health and Development Policy and Plan of Action both identify
adolescent and youth SRH as a key priority component and outlines key priority actions to be
instituted to address the SRH problems of adolescents (Godia et al, 2014). Current estimates
show that only 7% of facilities are able to provide youth friendly HIV counselling and testing
services, a decline from the 12% of facilities reported in 2004 (NCAPD, MOPHS, 2010).
Confidentiality, short waiting time, ability to obtain all services at one site and HSP attitude are
rated important youth friendly services characteristics by young people in Kenya, although girls
are more likely than boys to rate a particular characteristic as “very important”.

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Uganda has the youngest population in the world with a median age of 15.2 and adolescents
comprise 24% of the population (The State of Uganda Population Report, 2018). The median age
at first sexual intercourse is 16.9 years (UBOS and ICF, 2017) and the teenage pregnancy rate in
Uganda is 25%, one of the highest in Sub-Saharan Africa (The State of Uganda Population
Report, 2018). The knowledge and use of contraceptives seem to be limited in this age group.
The modern contraceptive prevalence among women age 15–24 is 21.8%. Seventy-five percent
of unmarried women aged 15–19 reported having received gifts or money in exchange for sex
(Olenaet al, 2019). Despite the evidence of early onset of sexual intercourse among adolescents,
contraceptive use is low, with only 9.4% among young people aged 15-19 reporting use of a
modern method (UBOS2016). This contributes to unplanned/unwanted pregnancies, unsafe
abortions and related complications, resulting in disproportionately high maternal mortality and
morbidity rates (Asingwire et al, 2019).

At Kamukuzi HC III, reproductive health care services have been minimal including advice on
some family planning methods. Moreover, due to inadequate health workers at the health centre,
no specialized reproductive health services have been availed to the youth to handle their unique
challenges (Kamukuzi Health Centre Records, 2019). As a result, most of the reproductive health
care services have not been accessed by a significant number of youth. In response, some of the
youth have ended up moving to Mbarara Municipal Health Centre IV which is always congested
with many patients with different health needs while others have resorted to traditional means to
deal with their reproductive health challenges. Moreover, there is limited data on availability and
accessibility of these RH services among young people. Where the process of providing
reproductive health care services has been attempted, limited documentation of the successes,
potential barriers and challenges has been made. Therefore, the aim of this study is to assess the
availability and accessibility of reproductive health care services among the youth taking
Kamukuzi Health centre III as a case study.

1.2 Problem statement

The ability to achieve sexual and reproductive health and rights, including being able to decide
whether and when to have children, is critical for the health and well-being of all youth. Greater
investment is essential to ensure that young people have access to age-appropriate,
comprehensive sexual education, as well as high-quality sexual and reproductive health services.

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Health services need to move beyond adolescent pregnancy and HIV to address the full range of
adolescents’ health and development needs such as reproductive health, positive living messages,
counseling among others (WHO, 2014). Young people must be empowered to make informed
sexual and reproductive health decisions in order to achieve their full potential (Guttmacher
Institute, 2019).

In Mbarara Municipality and Uganda at large, youth reproductive health (RH) is often
surrounded with myths and beliefs that may promote more risky behavior. Some of these myths
include; You can't get pregnant during your monthly periods, You can't get pregnant if a man
withdraws before ejaculation, You can't get pregnant the first time you have sex, Your testicles
will be damaged if you don't have sex when you're turned on or if you haven't had sex in a long
time. The score card by Care International Community (2017) identified a number of issues,
including: poor provision of youth-friendly services, little respect for young people from health
workers, understaffing, and limited resources for youth-focused outreaches in Mbarara district.
These have often increased the risk for other STIs and negative reproductive health outcomes
which include unintended teenage pregnancy, a risk factor for poor maternal health outcomes
(Akatukwasa, et al, 2019). The most important source of reproductive health information to the
youth has been schools or teachers, the second most important source being parents or guardians
(Olenaet al, 2019).

The above state of events reveals that accessibility of reproductive health care services is still
limited among the majority youth who are not in school and whose relationship with parents in
reproductive health matters is almost nonexistent. This is in addition to poorly resourced
government health facilities that would have closed the availability gap. Given that youths in
Uganda represent almost 20% of the total population, attempts to achieve optimal SRH on a
national scale must address the knowledge, availability and access to SRH services of this group
(Hervish and Clifton, 2012). This calls for a study to assess the availability and accessibility of
reproductive health care services among the youth, taking Kamukuzi HC III in Kamukuzi
division, Mbarara municipality as a case study.

1.3 General objective

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The general objective of the study is to assess the availability and accessibility of reproductive
health care services among the youth in Kamukuzi HC III Mbarara municipality.

1.4 Specific objectives

i. To establish the existing reproductive health care services available for the youth at
Kamukuzi HC III in Mbarara municipality

ii. To find out the reproductive health care services that are accessible by to the youth at
Kamukuzi HC III in Mbarara municipality

iii. To establish challenges limiting availability and accessibility of reproductive health care
services among the youth in Kamukuzi HC III Mbarara municipality.

iv. To suggest practical measures that can be used to increase availability and accessibility of
reproductive health care services among the youth in Kamukuzi HC III Mbarara
municipality.

1.5 Research questions

i. What are the existing reproductive health care services for the youth at Kamukuzi HC III
Mbarara Municipality?

ii. Which reproductive health care services are accessible by the youth at Kamukuzi HC III
in Mbarara Municipality?

iii. What are the challenges limiting availability and accessibility of reproductive health care
services among the youth in Kamukuzi HC III Mbarara Municipality.

v. What are some of the practical measures that can be used to increase availability and
accessibility of reproductive health care services among the youth in Kamukuzi HC III
Mbarara municipality?

1.6 Scope of the study

1.6.1 Geographical scope

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The study will be conducted at Kamukuzi Health Centre III. It is located in Kamukuzi division,
Mbarara Municipality. Mbarara Municipality in South Western Uganda is located 250km
southwest of the capital, Kampala. The Municipality has a population size of close to half a
million residents. At Kamukuzi HC III, major drugs, especially for malaria are available although
concerns are raised over the lack of key essential drugs meant to cure common illnesses. At the
same time, the state of health services is deficient in some aspects whereby the health centre is
understaffed, staff are reporting late for duty, unethical conduct of the medical staff and closing
the health centres on Saturdays and Sundays.

1.6.2 Content scope

The study will be limited to existing reproductive health care services for the youth, reproductive
health care services accessible by the youth and the challenges limiting availability and
accessibility of reproductive health care services among the youth in Kamukuzi HC III Mbarara
Municipality

1.6.3 Time scope

The study will be carried out within a period of 10 months from August 2019 did we start in
august? to June 2020. It will mainly review literature for a period between 2010 and 2019
because during this time issues of reproductive health care services have been brought to the
forefront by stakeholders and studies have been done to provide information on the progress in
different societies. The information from these studies will help to enrich the current study with
reference to availability and access to RHS in Kamukuzi, Mbarara in Uganda.

1.7 Significance of the study

Optimizing availability and accessibility to reproductive health services is expected to be a key

step to mitigating the high risk sexual behaviours among the youth.

Focusing on challenges limiting access to RHS by the youth is expected to provide an in-depth
understanding of the challenges that youth face in accessing these services. This information is
expected to improve the reproductive health outcomes for the youth.

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The ministry of health and line departments are expected to obtain relevant information
concerning the current trends as far as availability and accessibility of reproductive health
services is concerned. This will enable them to react appropriately by improving upon weak
areas to harmonise provision of reproductive health services among the youth.

To the future researchers, the findings from the study are hoped to provide baseline data that may
be used in form of literature.

CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

The literature review describes issues of availability of SRH services for the youth, level of
accessibility of reproductive health care services among the youth and challenges limiting
availability and accessibility of reproductive health care services among the youth. It contains
literature around the globe and is reviewed thematically based on study objectives.

2.1 Existing reproductive health care services for the youth in government health
centres

There is clear evidence that well-implemented gender-transformative approaches at the

community level with men can bring about significant changes in their attitudes and practices
related to gender, SRH and HIV, improving the well-being of women and girls, and of men and
adolescent boys themselves (WHO (2007). This evidence is supported by governmental
commitments at national, regional and global levels to strengthen work with men and adolescent
boys. While the provision of some SRH services may be challenging given resource constraints
in low- and middle-income settings as well as prevailing harmful gender norms, evidence from
such contexts demonstrates that it is possible and beneficial for the health development of
women, newborns and children when men are engaged positively. It is therefore essential to
scale-up work on men’s SRH within current provision, in order to build effective clinical and
preventive services for all people, and to promote healthier and equitable relationships in both
homes and communities (Pascoe et al, 2012).

Offer couple counselling to male and female partners during family planning visits and provide
only if female partner consents to this. Provide information (individually or with couples) on the

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various types of contraceptive methods, and their effectiveness, merits, and side effects, and help
the couple/individual client choose a method and explain its use. As most methods are female-
controlled, encouraging couple communication around family planning, and that men provide
support to their partners in this area, is essential (including the lactational amenorrhea method
(LAM) and fertility awareness methods) and the man’s role in supporting his partner in
effectively following these methods. Highlight the importance of triple protection from HIV,
other STIs, and unintended pregnancy, and that family planning can help women and men plan
and space births and prevent unintended pregnancy.

In accordance with ICPD agreement, adolescent reproductive health services (ARHS) include:
(a) Provision of information, education and counselling on sexuality, RH and parenthood to
reduce risky behaviour (b) Provision of information, counselling and services such as pregnancy
prevention, and prevention and treatment of HIV and other sexually transmitted infections (STIs)
to reduce the harmful effects of risky behaviour (c) Management of abortion related services and
where legal, safe abortion services. (d) Prenatal, postnatal and delivery care (UN, 1994;
Pathfinder International, 2001; WHO, 2004a).

Nigeria‟s commitment to the ICPD to provide the broadest possible reproductive health benefits
is revealed in the development of the National Reproductive Health Policy and Strategy (FMOH,
2001). The main priority areas of the policy are adapted from the ICPD and use strategies like
the promotion of healthy RH behaviour, advocacy and equity for access to quality health
services. Other areas include capacity building of individuals and youth-focused organizations in
Nigeria that promote ARH, collaboration between governmental and Non-Governmental
Organizations (NGO) and research promotion. The National Policy on Health and Development
of Adolescents and Young People in Nigeria was developed in 2007. It highlights the importance
of access to information and youth-friendly services (FMOH, 2007).

Evidence indicates that adolescents in developing countries underutilize RHS. A report on a

survey from 70 developing countries on adolescents‟ use of RHS presented data related to
contraceptive use, care-seeking for STDs and testing for HIV (Woog, Singh, Browne & Philbin,
2015).

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Youth-friendly services are usually designed to make the use of existing RHS more acceptable
and appealing to young people. Based on years of research and expert consultations the WHO
(2009) identified five key dimensions of YFS: Equitable, accessible, acceptable, appropriate and
effective. TheWHO found that ASRH interventions could increase adolescents‟ use of services
provided that the service providers were trained, health facilities were adolescent-friendly,
demand is created and community support is achieved through actions like extensive community
mobilization and targeting of key gatekeepers (WHO, 2006b).

In order to improve young people’s sexual and reproductive health and rights (SRHR), 12
organizations joined forces in the Uganda SRHR Alliance. They work with communities, schools
and health centres in eight districts in Eastern and Northern Uganda to ensure that youth have
access to the information and services they need to make healthy choices on their sexuality and
relations. As part of this work, the Alliance has advocated for the provision of youth-friendly
services by medium sized health centres (level 3 and 4) in their districts of focus (SRHR, 2015).

2.2 Reproductive health care services that are accessible by the youth in government
health centres find more data on this objective.

The findings revealed that accessibility to modern contraceptive was low among married
adolescents in all regions of Africa. Only a minority of sexually active adolescent women who
had an STD sought care at a health facility. The proportion of adolescent women who had been
tested for HIV 12 months prior to the survey ranged from 2% in Western African countries to
34% in Southern African countries. Similar evidence exists in sub-Saharan African countries
where it has been reported that many adolescents also underuse RHS (IPPF, 2010). Unmet
contraception needs among adolescents is as high as 60% in some areas of sub-Saharan Africa
and South Asia (UNFPA, 2013b).

Another survey conducted in 41 Sub Saharan Africa countries from 1990-2011 revealed that in
the majority of countries, less than 10% of adolescent women report the accessibility of a
modern contraceptive method (Kothari, Wang, Head & Abderrahim, 2012).

Low accessibility to and utilization of RH services creates a universal concern since unintended
pregnancies, unsafe abortions, and sexually transmitted infections (STIs) have been shown to

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contribute to high morbidity and mortality rates, especially in developing countries (Izugbara &
Ngilangwa, 2010; Simoes & Almeida, 2011). Is this a service or a challenge?

The stigmatization of premarital sexual relations among young women deters them from seeking
information about RH, engaging in safer sex and fulfilling their RH needs (Kaljee et al, 2010).
Those disparities of access to RH care affect not only the individuals but also their families,
society and health systems as a whole at both national and global levels (Singh, 2010;
Adinma&Adinma, 2011). Therefore, the inequity of access to RH services between the rich and
the poor, and those living in urban and rural areas are a global equity issue of high priority. The
study objective is clear and looking at services that are accessible to the youth not what hinders
them from accessing these services.

2.3 Challenges limiting availability and accessibility of Reproductive Health care

services among the youth in government health centres

A series of multifaceted factors prohibit good SRH for adolescents. Sexual and reproductive
behaviours are governed by complex social, economic, cultural and psychosocial factors (WHO,
2011c). A study done in Burkina Faso, Ghana, Malawi, and Uganda showed that contraceptive,
STI and voluntary counselling and testing (VCT) services are still under-utilized by adolescents
due to their lack of knowledge about the services (Biddlecom et al, 2007). The study found that
lack of understanding of the importance of sexual health care or knowledge of where to go for
care discourages young people from using the services. There is also evidence that the more
educated youths are the more likely they are to seek youth-friendly health services as they
possess a better understanding of their health needs (Rani & Lule, 2004).

On an individual level, embarrassment in seeking RHS has been reported in various studies as
barriers to adolescent’s access to RHS (Regmi, Van Teijlingen, Simkhada & Acharya 2010).
Shyness was the most commonly reported reason among adolescent boys (69%) and the second
commonest reason for adolescent girls for not accessing RHS in a study conducted in Nepal
(UNFPA, 2015).Studies have reported on the preference of adolescents to see health providers of
the same sex as a barrier to utilization of services (Ghafari, Shamsuddin & Amiri, 2014; Newton
Levinson, Leichliter & Chandra-Mouli, 2016). For example, a study in Malawi reported

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adolescents not accessing services because they had problems with explaining genital issues to a
provider of the opposite gender (Munthali & Zakeyo, 2011).

With regard to gender inequity, in many countries around the world, women and girls have still
been found to have lower status, fewer opportunities and lower income, less control over
resources and less power than men and boys. These gender roles may weaken the young
women’s ability to protect themselves and gain access to the services they need (Woog et al,
2015). When young women are submissive they lack autonomy and ability to make decisions on
SRH issues and this increases vulnerability which has been found to limit their access to
reproductive health information, services and contraceptives (Morris & Rushwan, 2015).

Cultural and religious factors create an unfavourable environment for discussion of ASRH due to
the strongly rooted sense of condemnation of adolescent sexual activity (Morris & Rushwan,
2015). Studies have shown that in cultures in which social norms do not condone premarital sex,
young people who are unmarried and experience sexual problems such as an STD or unplanned
pregnancy will probably address the issue on their own. In communities where premarital sexual
activity is not condoned, adolescents have been found to have limited access to RHS and
information. Studies have also shown that religion is a major barrier to adolescents‟ utilization of
RHS (Upadhyay, 2016).

A study in Tanzania reported that adolescents do not seek formal treatment for reproductive
health problems as a result of shame and fear of disclosure (Nyblade, Stockton, Nyato &
Wamoyi 2017). Another study conducted in Australia revealed that young people were
discouraged from visiting clinics because of fear of the possible stigma attached to ARHS
(Rickwood, Deane, Wilson & Ciarrochi, 2010). Young people fear stigma and repercussions or
judgment from providers, family and communities which hinder them from accessing RHS,
particularly unmarried adolescents and especially girls (UNFPA, 2015).

In many developing countries, providing universal access to sexual and RH care for adolescents
is beyond the health systems‟ capacity. In some cases even where the health facilities exist, there
is not enough trained staff to provide the needed services and supplies of drugs and
contraceptives are limited (Woog et al, 2015). Poor health systems with weak infrastructure for
sexual health, communications and transport can make access to services in rural areas

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particularly difficult (Kabiru, Izugbara & Beguy, 2013). For example, in Nigeria a principal
barrier to providing adequate comprehensive ARHS has been the lack of provision of adequate
resources (funding, personnel, infrastructure and supplies) especially at the sub-national level for
implementation of the ICPD-aligned policies, programs and services (Mandara, 2012).

Health workers behaviours can also significantly hinder adolescents‟ utilization of RHS.
Services need to be provided in a youth-friendly environment with health workers that are
welcoming and supportive towards adolescents seeking care (Jonas, Crutzen, van den Borne &
Reddy, 2017). It is clear that interventions which aim to address the negative attitudes of health
workers are likely to improve adolescents‟ RHS utilization (Jonas, Crutzen, van den Borne &
Reddy, 2017). Other important health service barriers that prevent young people from obtaining
sexual and reproductive health services include inconvenient location and hours of operation of
facilities and the cost of services (WHO, 2012).

The methodology should go on a fresh page.

CHAPTER THREE: METHODOLOGY

3.0 Introduction

This chapter describes the methodology that will be used in this research study. It outlines the
study design, study population and sampling procedures to be used. It also describes the data
collection tools and the process of data collection and goes further, describing the data analysis
procedures. It addresses the issues of rigour??? and the limitations of the methodology used.
Finally, the ethical considerations of the study are highlighted.

3.1 Study design

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A cross-sectional study design will be used whereby youth whose age range is between 18 and
30 years who visit the health centre during the study period will be involved. The cross sectional
study design will be used because it is needed to describe the phenomenon as it is on the ground.
The design is intended to help in examining the availability and accessibility to RHS as they
exist in a defined population at a single point in time or over a short period of time. Both
qualitative and quantitative methods will be used. Qualitative approach will be used in the study
because it will help to tap information that will be obtained through the use of qualitative
approach. Quantitative method will involve collecting data that is measurable.

3.2 Study population

The study population will comprise of the youth and health workers. The youth visiting the OPD
department at Kamukuzi health centre III will be used because they are the ones that are targeted
with reproductive health services. Hence they will be in position to tell whether these services
are available and accessible when needed. The health workers will be involved because they are
the service providers and thus will be able to show the changing trends in the availability and
accessibility of RH services among the youth.

3.3 Inclusion and Exclusion Criteria

Inclusion criteria

 All youth whose age ranges between 18 and 30 years

 All youth aged 18-30 years attending Kamukuzi health centre III for reproductive health
services
 All youth found at Kamukuzi HC III who consent to participate in the study

Exclusion criteria

 All youth aged below 18 years and above 30 years

 All youth aged 18-30 years not found at Kamukuzi HC III
 All youth aged 18-30 years who do not consent to participate in the study

3.4 Sample size determination

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Following Cochran (1977), the suitable sample size will be determined on the basis of the
standard formula given by Cochrane W. G (1977) as:

N= Z2 P (1-P)

d2

N= Sample size,

P=Prevalence of access to RH services among the youth at 12%,

d=0.05 (allowable error of known prevalence),

Z= 1.96

N= 1.96*1.96*0.12*(1-0.12)

0.05*0.05

N= 1.96*1.96*0.12*0.88

0.05*0.05

N= 0.405 I remember asking for an explanation of this formula.

0.0025

N= 162 are these two in any way related?

Given the limited time for the study and the anticipated low level of access to reproductive health
services by the youth, only 60% of the obtained sample size of 120 will be considered. Therefore
a sample size of 97 youth in the age bracket 18-30 years will finally be recruited for the study.
To cover this sample size, the researcher expects to meet an average of between 8 and 9 youths
per day and will cover the sample after 11 days. In addition to this number, 3 health workers will
be selected at Kamukuzi Health Centre III to take part in the study. As a result, a total sample of
100 respondents will be selected for the study. Bearing in mind the time remaining for the course
due to COVID-19 interruptions.

3.5 Sample selection techniques

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Consecutive sampling will be used to select population elements that satisfy the selection criteria
. Consecutive sampling is a sampling technique in which every subject meeting the criteria of
inclusion is selected until the required sample size is achieved . The sampling technique will
involve dividing the study population into homogenous groups based on days of visits at the
health centre . The health centre works from Monday to Friday every week and receives about
10 youth per day. Therefore, using consecutive sampling, respondents will be selected based on
the visits until the required sample is constituted. The selection will generate a total of 9 patients
per day and 45 per week and is expected to be completed in the beginning of the third week from
the date of commencement of data collection.

For the health workers, purposive sampling will be used basing on the knowledge of a topical
issue and the purpose of the study. The subjects will be selected because of some unique
characteristic. The researcher will use purposive sampling on health workers because this
category of respondents is knowledgeable on the subject matter. This method will be used
because it helps in acquiring specific information that cannot be given by any respondent in the
field.

3.6 Data collection methods where are they? Talk about methods separately.
3.7Data collection tools

3.7.1 Questionnaires

The researcher will use a questionnaire as the main data collection tool. A questionnaire is a
written form of questions that are systematically arranged to enable the researcher come up with
clear findings that can answer the research questions in order to achieve research objectives.
Questionnaires are the most generally used instruments of all according to Langford (2001)
because they are “easy to administer, inexpensive and offer anonymity”. A questionnaire is the
best instrument because it gives the respondents time to fill them without being intimidated by
the researcher’s presence and saves time. The researcher will use a structured questionnaire to
collect data from the youth aged 18 to 30 years. In order to cater for the respondents that are
uneducated and less educated, the researcher will try to translate some questionnaires for them.
The researcher will use a 5-likert scale type of questionnaire using codes to represent the

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responses as; 1, 2, 3, 4 and 5 whereby 1 = Strongly Agree, 2 = Agree, 3 = Not sure, 4 = Disagree,
5 = Strongly disagree.

3.7.2 Interview Guide

Interview guide is another used data collection tool where the researcher will ask questions
directly to the respondents. With this method, the researcher will ask open ended questions to
health workers. Besides, interviews will allow the researcher to probe and collect the most
necessary information. The researcher will use this method because it generates quick response
as respondents give immediate feedback. The researcher will conduct interviews with the help of
an interview guide that will help the researcher to collect data that is in line with the objectives of
the study. It will assist the researcher to keep in truck with the research problem.

3.7 Research procedure

The researcher will be given an introductory letter from the University after the proposal is
approved. The letter of introduction will assist the researcher to get authorization from the
authorities in Mbarara municipality to conduct a study in the area. Approval to carry out the
study will be sought from the DHO’s office at Mbarara Municipality. After permission is
granted, the researcher will move on to seek informed consent from the respondents and then
start on data collection.

3.8.1 Validity of instruments

Validity refers to the ability of a tool to measure what it is supposed to measure. It is the degree
to which the results are truthful. Validity of research instruments will be studied using content
validity index. Content Validity Index will be calculated basing on judgment by at least two
knowledgeable people (Judges). If the results got are above 0.7, the instrument will be deemed
valid for use and once the obtained value is less than 0.7, then it will be revised and subjected to
the same test until valid results are obtained.

3.8.2 Reliability of instruments

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It is a measure of the degree to which a research instrument yields consistent results/data after repeated
trials (Oluwatayo, 2012). To establish the reliability of the instrument, the researcher will use SPSS
to compute the reliability indices based on the thematic areas. Cronbach’s Alpha co-efficient
formula will be used to compute reliability of the instrument and if the obtained alpha values are
found to be 0.7 above, then reliability will be significant and the tool will be deemed valid for
data collection.

3.9 Data Analysis

The data collected will be analyzed both qualitatively and quantitatively since it will use both
methods in the research design. The questionnaire will be analyzed using frequency counts and
percentages.

3.9.1 Qualitative data analysis

The qualitative data analysis was used to find availability and accessibility of RH services and
recording will be done and some conclusions made in the field in order to corroborate
quantitative data. It will be collected through the use of interview guide and recording of
respondents’ views will be done after which some will be reported verbatim for some
conclusions to be made in relation to study themes.

3.9.2 Quantitative data analysis

This method will be used to find out the extent of availability and accessibility to RH services
among the youth. After coding the responses, they will be fed into computer using the Statistical
Package for Social Scientists (SPSS) Version 25.0 and processed into statistical data that could
be interpreted easily. Using SPSS descriptive statistics will be generated in form of frequencies,
percentages, mean and standard deviation.

19
20
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28. UNFPA. (2015). The Qualitative Study on Assessing Supply Side Constraints Affecting
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Appendices

Appendix 1: Questionnaire for the youth aged 18-30 years

Dear respondent,

I’m introduce yourself here. carrying a study titled: Availability and accessibility of reproductive
health care services among the youth in Kamukuzi Division, Mbarara Municipality; a case of
Kamukuzi Health Centre III. Either bold or italicize the title.This is a research leading to the
award Bachelor`s Degree in s Social w Work and s Social a Administration of Bishop Stuart
University. The purpose of this study is purely academic. You are humbly requested to freely
express your opinion on each of the issues raised as objectively as possible. The information that
you provide will be treated with utmost confidentiality. The basic research ethics are to be
observed and adhered to while administering this questionnaire.

Your positive and quick response will be highly appreciated.

Thank you for your cooperation

Yours truly, Sharifah Nakintu

Section A: Demographic Data

In this part of the questionnaire, you are requested to tick inside the box against the answer of
your choice that suits your choice.

1. Age

21-30 years 31-40 years

41-50 years 51 and above

Refer to your age bracket for the youth.

2. Sex

Male Female

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3. Level of education

Primary Secondary

Tertiary University

Uneducated

4. Have you ever accessed sexual reproductive health services at this health centre?

Yes No should also be put in your Likert scale

In the remaining part of the questionnaire, you are requested to express your opinion by ticking
an option which you think is the most appropriate. Thematic areas are being considered, please
simply tick the most appropriate alternative

Scale: 1=Strongly Agree, 2=Agree, 3= Undecided, 4=Disagree, 5=Strongly disagree

Section B: Existing reproductive health care services for the youth in 1 2 3 4 5

Kamukuzi Health Centre III

5. Couple counseling for youth??? is one of the reproductive health services

available at the health centre

6. Voluntary counseling and testing for HIV is among the services offered at
the health centre III

7. Counseling on sexuality among the youth is also provided at Kamukuzi

health centre III

8. Prenatal, postnatal and delivery care services are provided to the youth at
Kamukuzi health centre III

9. Youth-friendly services are rarely used at Kamukuzi health centre III

10.Outreach programs on youth reproductive health is done by Kamukuzi

health centre III to reach out to youth with various related services

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SECTION C: Reproductive health care services that are accessible by the
youth at Kamukuzi health centre III

11. There is low accessibility of reproductive health services among adolescent

couples

12. More male than female youth are accessing reproductive health services

13. Approvals are made after ensuring that funds are available for effecting
payment of retirement benefits

14. Reproductive health education is rarely accessed by the youth at

Kamukuzi health centre III

15. Accessibility of reproductive health services among the youth goes with
age

16. VCT services are accessed by the youth at Kamukuzi health centre III

SECTION D: Challenges limiting availability and accessibility of

Reproductive Health care services among the youth in government health
centres

17.Young women and girls have still been found to have lower status, fewer
opportunities and less power than men and boys which hinders their
accessibility to reproductive health services

18. Religious factors create an unfavourable environment for discussion of

SRH due to the strongly rooted sense of condemnation of adolescent sexual
activity

19. Some adolescents do not seek formal treatment for reproductive health
problems as a result of shame and fear of disclosure

20. There is limited trained staff to provide the needed reproductive health
services among the youth

21. More often, supplies of drugs and contraceptives are limited at Kamukuzi
health centre III

22. Health workers’ behaviours can also hinder youth utilization of

reproductive health services.

23. Lack of youth friendly health services at Kamukuzi Health centre is among
the limiting factors to accessing RHS

Where are the options for objective four?

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Use short(er) statements

END

Thanks for your co-operation

I think you are not differentiating between accessibility and availability. Your
options for objective two are lacking. Please revise and consider only those services
that are accessible (d) by the youth.

Appendix 2: Interview guide for health workers transfer to a fresh page.

1. How often do you provide reproductive health services at Kamukuzi health centre III?
Do they have those services in the first place?
2. Mention some of the reproductive health services that are commonly available for
youth in Kamukuzi health centre III?
3. What are some of the reproductive health services that are rarely available at
Kamukuzi health centre III?
4. What causes irregular availability of some youth reproductive health services?
5. Are the majority youth accessing the existing reproductive health services?
a) Yes
b) No
6. If yes, mention the reproductive health services that are mostly accessed by the youth
7. If no, why?
8. How do you rate the level of accessibility of reproductive health services among the
youth?
9. Are there challenges limiting availability and accessibility to reproductive health
services by the youth?
a) Yes
b) No
10. If yes, what are the health facility related challenges limiting availability and
accessibility to reproductive health services by the youth?
11. What are the other challenges hindering availability and accessibility to reproductive
health services by the youth?

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12. What do you suggest as the measures for increasing availability and accessibility?
Ask whether there has been any measure in place to solve the problem?

Attend to the queries, harmonise the tools and then proceed for data
collection.

29