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"There are bugs in condoms": Tanzanian close-to-community providers' ability to offer effective adolescent reproductive health services

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Dusabe-Richards, John, Mchome, Z., Nnko, S., Changalucha, J. and Obasi, Angela (2014) '"There are bugs in condoms": Tanzanian close-to-community providers' ability to offer effective adolescent reproductive health services'. Journal of Family Planning and Reproductive Health Care, Vol 41, Issue 1, e2.

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Abstract

Objectives
Young people in Tanzania are known to access reproductive health services from a range of close-to-community providers outside formal health settings such as drug stores, village AIDS committees, traditional healers and traditional birth attendants (TBAs). However, questions remain about the quality of services such agents provide. This study investigated their capacity to provide adolescent reproductive health (ARH) services and explored their readiness and ability to integrate with the mainstream health sector through community referral interventions.

Methods
Thirty-five focus group discussions exploring close-to-community provider experiences and attitudes to ARH service provision were carried out in two districts in Northern Tanzania. Discussions were conducted in Kiswahili, digitally recorded, verbatim-transcribed, translated and back-translated from Swahili to English. A thematic analysis was conducted using NVivo 9.

Results
The major close-to-community cadres providing reproductive health services were drug stores, traditional healers, TBAs and village health workers. They reported being the first port of call for adolescents seeking reproductive health services, but their knowledge of ARH needs was poor. They had negative attitudes to, and lacked the necessary resources for, the provision of such services for adolescents. Some were particularly unwilling to provide condom services and were prejudiced against adolescents using them. There was poor integration between the close-to-community providers and the formal health sector, further limiting their ability to provide adequate services.

Conclusions
Although close-to-community providers are considered a key resource in the community, most have limited capacity to provide ARH services. Without capacity-building investments such as training and cooperation with the mainstream health sector, their contribution to positive reproductive health outcomes is limited, or could indeed lead to adverse outcomes.

Item Type: Article
Subjects: QV Pharmacology > Reproductive Control Agents > QV 177 Contraceptives
WA Public Health > Health Administration and Organization > WA 550 Family planning
WA Public Health > Health Administration and Organization > WA 590 Health education, Health communication
WS Pediatrics > By Age Groups > WS 460 Adolescence (General)
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1136/jfprhc-2014-100915
Depositing User: Tina Bowers
Date Deposited: 11 Dec 2014 12:13
Last Modified: 06 Feb 2018 13:08
URI: http://archive.lstmed.ac.uk/id/eprint/4609

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