Access to healthcare amongst adolescent girls and young women in Ugandan artisanal and small-scale mining communities

Artisanal small scale-mining (ASM) provides work to many adolescent girls and young women (AGYW) in Uganda. AGYW working in ASM face a unique set of health challenges such as exposure to mercury, HIV and sexually transmitted infections. AGYW in ASM are more vulnerable since they work and live in remote areas with limited health infrastructure which may limit their access to care. However, the AGYW’s access to care, including SRH care, is not well understood or documented. This paper aims to explore the current healthcare access challenges and bottlenecks amongst Ugandan AGYW working in ASM communities.

The findings are part of a large study which was conducted in Busia, Mubende, and Namayingo communities, from three mining regions in Uganda. While the large study employed a mixed methods approach involving a survey with AGYW and qualitative data (in depth interviews, focus group discussions with adolescent boys, older women, and AGYW, key informant interviews with local leaders and policymakers). Data were analyzed deductively based on the Tanahashi Model on access to care.

Overall, AGYW working in ASM communities expressed interest in using the health care facilities to treat their illnesses and for family planning services. However, with the exception of a few, they reported various challenges they face in accessing healthcare. All participants discussed challenges such as lack of personnel at facilities, lack of youth friendly health services, limited resources, distance to facilities, cost of care, and negative provider attitudes especially towards sexual and reproductive health care for unmarried AGYW.

Despite some availability, accessibility, acceptability, and contact coverage, the gaps in AGYW’s access to healthcare highlight a critical need to avail and strengthen health systems and especially sexual and reproductive health care in ASM communities in Uganda. This will contribute to achieving UHC and ultimately health equity. Mitigating the inequities in accessing care amongst ASM AGYW involves processes such as formalization, advocacy and rights-based accountability, and leveraging existing initiatives proposed in national Ugandan health policies.