Young women are the group most at risk of contracting HIV in Zambia today. Many teenage girls also become pregnant before reaching the age of majority. In order to see more young people get information about sex and health, health clinics have also trained young volunteers who then receive young patients. They give advice and information to their peers using the tools of drama and dialogue.
In the shade of a tree outside Kaonga Urban Clinic, 13 young volunteers sit on wooden benches. This is a kind of youth corner where young patients coming to the clinic can receive help.
“It might feel easier for a young person coming here in need of help to talk to me first. I can then present their case to a nurse and point them in the right direction,” says Joseph Chiwokoli, one of the young volunteers taking turns every day to be at the clinic.
Kaonga is one of three health clinics in Mazabuka district to have created informal places where young volunteers receive young people. The volunteers also visit rural schools and villages, performing theatre to create dialogue about the problems that unprotected sex can bring. The play, written by Kaonga’s volunteers themselves, is about a young man who has three girlfriends at the same time. One of them contracts HIV and two become pregnant. The message they want to get across is that his desire to explore his masculinity without taking his partners into account had a very unhappy ending.
The play is followed by conversation in classes, with discussions of issues such as why condoms are important, that witch doctors cannot cure sexually transmitted diseases or that abortion is actually legal and permitted, which not everyone knows. The young people who want contraceptives or other help are asked to visit the clinic.
“In my class, I saw a lot of girls get pregnant, and I wanted to try to counter it. That’s why I’ve got involved in this, and I talk to my male friends about using condoms or abstaining from sex,” says Muthanuka Siambango, when asked why he chose to spend parts of his free time on volunteer work.
Obraim Nyambe relates how incredibly shy he was the first time he visited a health clinic. He stood in a corner and waited until a young volunteer came up and asked what he needed.
“They helped me so much and gave me good advice, so I felt that I wanted to become a youth volunteer and help others.”
HIV and AIDS is a major problem in Zambia. It is estimated that around 12 per cent of the population between the ages of 15 and 49 years are infected. In the 20–24 age group, women are four times more affected than men. Therefore, it is important that young people become aware of how to protect themselves and where they can get help. Teenage pregnancy is another major problem; 42 per cent of all 18-year-old girls are already married and many have already had their first child.
Although the national statistics are still alarming, the clinic's employees nevertheless see that the work with volunteers and special youth corners has produced some positive results: Fewer teenage pregnancies, fewer unsafe abortions and more people visiting the clinic.
Swedish support for better health
The investment in young people's sexual and reproductive health and rights is part of a major programme that Sida is financing to give children, mothers and young people better access to good healthcare and ultimately improve their health.
Since the support goes via the Zambian Ministry of Health, it is the Government that has the final responsibility for improving healthcare at the district level. In recent years, following the discovery of a corruption case in the public health sector in 2009, health support has mainly gone to non-governmental organisations. But now the Government has improved its control and management systems, and Sida has taken several measures to counteract corruption.
“We have, among other things, required districts to introduce a new accounting system before they may receive money, and financial managers must have received training in it,” says Ulrika Hertel, programme officer for the support at the Embassy of Sweden in Lusaka.
This dramatically reduces the risk of corruption compared to the manual accounting that the districts previously used and where it was easy change figures.
“Procurement and risk mitigation measures have taken time in the beginning, but now the various districts’ action plans can be implemented and more midwives employed, for example. This is needed to improve healthcare and provide the right service for young people,” says Ulrika Hertel.