Plenary 6 - Sustaining Quality of Care in the Public Health System: The journey so far, Challenges and Prospect

Background
Globally there are over 7.9 billion persons of which 16.7% are Adolescents and Young People (AYP), 90% of whom live in low-developing countries, with 40% from Africa. Sub-Saharan Africa has the highest pregnancy rate (218 per 1,000 women), lowest rate of contraceptive use and about 33 abortions occurring per 1,000 women aged 15-49 years annually. This study aimed to understand the gender-based influences on SRH outcomes among AYPs in Luuka district, Uganda.


Methods
A Qualitative thematic analysis between June and July 2022, we conducted 8 Focus Group Discussions (FGDs) with 8-12 purposively selected AYPs between the age of 15-24years in 2 sub-counties in Luuka District, Uganda. Four FGDs in Ikumbya sub-county consisting of 2 male groups and 2 female groups among 15-17years in-school AYPs. Four FGDs in Bokooma sub-county, 2 male groups and 2 female groups among 18-24years out-of-school AYPs. 
We explored the SRHR needs of AYP, examined a typical growth timeline for female AYPs and the key growth in social and cultural critical events that occur in the AYPs growth pathways in Uganda were explored. 
Interviews were audio-recorded, transcribed, translated, and data analyzed thematically. 


Results
Unwanted pregnancies, forced marriages, and unregulated abortions are reported as key life events. Negative societal norms - women seen as sex objects and a source of income for parents, household duties exclusive to be done by females, lower female self-esteem, and negative myths on family planning (male mainly) were highlighted as major barriers to contraceptive access and use despite the need.


Conclusion
SRHR policies and programs should aim at mindset and behavioural change using intergenerational dialogues and advocacy with deliberate actions on breaking negative societal norms and stereotypes. Contraceptive promotion and empowerment campaigns that are gender sensitive should also be adopted.

Background 
LGBTQi+ adolescents and young persons experience inequitable health service provision for contraception in public health facilities due to their gender, age, biological sexuality and sexual orientation, and the discriminatory behaviors and attitude of the community and of healthcare providers towards their health. This discriminatory behavior is twice for the LGBTQi+ AYPs. Digital education has been noted as a potential solution to increase the delivery of health professions education and addressing their attitude towards recognizing that health care services is supposed to be delivered to everyone irrespective of their gender and sexual orientation. Therefore, this study evaluates the influence of a digital training course on attitude of health care providers towards rendering Sexual and Reproductive Health (SRH) services for LGBTQi+ AYPs. 
Method
The study adopted a mix method approach where quantitative data were collected from a pre-post assessment of 20 providers trained on a digital platform. Similarly, 70% of the participants were randomly selected for an In-Depth Interview (IDI) on their attitude towards providing SRH service for adolescents including LGBTQi+. 
Result
The result showed that 85% of the providers had a low attitude towards SRH service provision towards adolescents particularly LGBTQi+. After the digital training, 95% expressed confidence and empathy towards understanding the SRH needs of AYPs and also willing to provide unbiased unstigmatized SRH services to AYPs which also include contraceptive services. The IDI result also showed 95% of the providers willing to be more empathetic in meeting the SRH needs of AYPs
Conclusions
This study concludes digital training is proving to be effective and adequate for the training of healthcare providers on SRHR services for gender sensitive care delivery for AYPs. 
Keywords: LGBTQi+, Digital Training Course, Attitude, Health Care Providers, Adolescents and Young Persons