The Global-Local Interface in Adolescent Sexual Health: A Review of Sub-Saharan Africa's Challenges

By Kudakwashe Dube, Marc Van der Putten, Nitaya Vajanapoom

Background: Globally, societal shifts and behavioral patterns aggravated by developmental vulnerabilities create a convergence of factors that place today’s adolescents at increased risks of adverse consequences for health (Bearinger, Sieving, Ferguson, & Sharma, 2007). Although there are global guidelines on Adolescents Sexual Reproductive Health (ASRH), countries continue to face difficulties in translation of these guidelines into national policies and action. There are recognized gaps in research regarding global-local interface and the effectiveness of existing ASRH policies and programs at the national, sub-national and local levels in low-income and middle-income countries (WHO, 2011). It is against this background that this review examined the global-local interface in ASRH.

Objective: To identify knowledge gaps for improvement of national adolescent sexual and reproductive health policies and programs in selected Sub-Saharan African (SSA) countries.

Methods: A comprehensive literature review applying a descriptive comparative documentary research design using quantitative and qualitative approaches in analyzing information from 1994-2012 scientific publications, unpublished reports, and documents available from public access search engines was used. The review study looked at both global and local context issues in translation of ASRH global guidelines into national policies and action and obstacles to program implementation in five SSA middle to low income countries namely Ghana, Nigeria, South Africa, Uganda and Zimbabwe.

Key findings: Adolescents are exposed to diverse interventions across all the reviewed SSA countries however there exist obstacles to realization of ASRH goals. In countries, there exist a conflict between national laws and global policy guidelines on ASRH, moreover national laws and policies are ambiguous and inconsistent. In addition, there have been strong negligence of vulnerable groups such as HIV positive adolescents, pregnancy street youth; young sex workers; orphans; adolescents in conflict areas; adolescent refugees; adolescent girls working in the informal sectors and very young adolescents, likewise many adolescents in rural areas remain largely underserved. Furthermore there are consistently less disaggregated data available on adolescents’ key indicators for comparative purposes signifying considerable knowledge gaps.

Conclusion: Findings point to multitudes of impeding factors across all countries reviewed in translation of ASRH global guidelines into national policy and action. Therefore there is need for future research to determine the extent to which factors are either conducive or impeding to consistency between global guidelines, national ASRH policies, and actual policy implementation. Additionally there is a dearth of evidence on effectiveness of ASRH interventions; therefore there is also need for evaluative studies evidencing effectiveness of ASRH interventions.