Abstract
ObjectivesRepresentation of the key groups in community-level healthcare decisions is a prerequisite for accountable and responsive primary healthcare systems. However, meaningful representation requires both the presence of individuals who represent the key community groups and their capacity to influence the key healthcare plans and decisions. Our study explored how the underrepresentation of the youth in health facility committees, the decentralized community- and facility-level healthcare decision-making forums affects youth access to sexual and reproductive health services.MethodsA multisite case study involving focus group discussions, interviews, and meeting observation was conducted in eight primary healthcare facilities in Kasulu, a rural district in Tanzania. Inductive thematic analysis was used to identify the key emerging themes.ResultsFive major themes were identified in connection with youth underrepresentation and limited access to sexual reproductive health as a ‘taboo’ phenomenon in the communities. These were: numbers do not matter, passive representation, sociopolitical gerontocracy, economic vulnerability, and mistrust and suspicion.ConclusionsGradual emancipatory and transformative efforts are needed to normalize the representation of the youth and their concerns in formal community-level decision-making institutions.
Highlights
The population of Africa is growing youthful
Five major themes were identified in connection with youth underrepresentation and limited access to sexual reproductive health as a ‘taboo’ phenomenon in the communities
Gradual emancipatory and transformative efforts are needed to normalize the representation of the youth and their concerns in formal community-level decision-making institutions
Summary
The population of Africa is growing youthful. Whereas the world’s youth population is expected to decrease from 16 to 14% by 2050, in Africa it is expected double (United Nations 2014). One of the reasons behind this growth is the higher fertility rate, which is 5.02 births per woman, declining maternal mortality rates (MMR), and gains in child survival. These projections present a message that youth access to health care will be an important aspect of the pursuit of Universal Health Coverage (Manyeh et al 2018). The pressure on health systems to meet the important, but currently unmet youth healthcare needs will be unescapable (Finlay et al 2020). Sexual and reproductive health (SRH) is one of (if not) the most important healthcare needs of the youth
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