"We need multi-sectoral solutions to solve SRHR risks for girls in Africa"

Dr. Alhadi Osman first became interested in gender equality and sexual and reproductive health and rights when he noticed the "terrible reproductive health outcomes of women, especially during pregnancy and delivery" in his native Sudan.

Dr. Osman, who trained as a medical doctor and later completed a Master’s in Public Health at the KIT Royal Tropical Institute in Amsterdam, is one of Women Deliver's 2020 cohort of Young Leaders. He currently works as a project officer at Health Management Support Team and has worked with several governments, NGOs, and youth-led initiatives on public health and reproductive health in Sudan and other countries. He is also involved in global health research in Sudan and neighboring countries, including exploring the linkages between health outcomes and conflict and energy issues.

As part of this year's series on the 2023 Women Deliver conference, Exemplars News spoke with Dr. Osman about the most significant challenges facing girls in Africa related to sexual and reproductive health and rights and how youth leaders could help contribute to overcoming them.

Why do you believe youth involvement is important and what are some of the challenges facing young leaders?

Dr. Osman: When we have a conversation about youth involvement or meaningful youth engagement, one issue I see is tokenism. People say, 'Well, how about we have young people in the table of discussion?' Then they end up not having any input in the discussion. They're there just because they're young people. Many times it's not done cynically. It's more that the young people, by default, often don't have much experience and don't have the ability to communicate their inputs and opinions. They need some capacity building along the way. We're now seeing more capacity building roles for young people around advocacy, about presenting research, presenting data, etc.

Let me give you an example. One of my friends attended a meeting on improving the lives of young girls in the Global South and no one at the meeting was below the age of 40, which was crazy. She was the only one and she was a last- minute invitee. She noticed that all the discussions were from the perspective of older people. They had a discussion about keeping girls in schools and the other attendees said things like, "If the girls are absent from schools because it stresses them out, we can provide counseling at the schools." A young person at the meeting would have said something like, "We actually don't have enough money to go to school in the first place or we need to support our parents." This input could have changed the conversation from counseling programs to providing cash transfers to young people to make them secure enough to go to school.

As a doctor and an MPH, what do you consider to be the most significant challenges facing girls in Africa related to sexual and reproductive health and rights?

Dr. Osman: Girls in African countries face similar problems to girls in other low- and middle-income countries, including medical problems and non-medical problems. For non-medical problems, we're often talking about harmful social norms. There are many of those and they affect the health of women and girls in Africa and beyond. For example, social pressures may put them at risk of early pregnancy, which when combined with a lack of access to reproductive health facilities, lack of access to family planning, or quality obstetric care, can be a major problem.

Another really massive problem is HIV, and the risk of contracting HIV or other sexually transmitted diseases, especially in conflict-affected settings. Girls don't have the tools to protect themselves from HIV. We're talking about knowledge, we're talking about access to family planning. But more importantly, in a systematic review we conducted last year we discussed how women and young girls are at the highest risk of contracting HIV because they're socially vulnerable to coerced sex and transactional sex to make a living. Yet, this often isn't on anyone's radar during humanitarian responses.

The bottom line is that the challenges faced by young girls are multi-faceted and interconnected. These challenges exacerbate one another and create complex obstacles. Multi-sectoral approaches are the key to addressing these issues comprehensively, rather than having silos in education, poverty, or health response. When addressing a girl with HIV, we must recognize her as a unique individual with diverse needs. Therefore, it is imperative for different organizations to collaborate and work together to tackle her problems holistically. If we only address poverty without simultaneously addressing HIV or education issues, we risk returning to the starting point since the problems remain interlinked.

What strategies or approaches do you believe could be effective in addressing these challenges? How can youth leaders contribute to overcoming these challenges?

Dr. Osman: Youth leaders must be part of movements and civic actions to work towards solving these problems. Everybody's trying to do things on their own, but there is room for a mass movement to solve problems related to sexual reproductive health in the African region and around the world. Women Deliver represents a great example of how this could be done. Our cohort includes 300 Young Leaders. We can see different solutions to different problems.

You have a particular interest in health systems in low- and middle-income countries. From your perspective, what could be done in LMICs to strengthen health systems for young people, especially for girls?

Dr. Osman: I don't personally believe that health system interventions are meant to serve a particular population. There are health system improvements that need to take place for health outcomes to be improved for everybody, including adolescents and women. I'm particularly thinking about strengthening health service delivery, which is one of the six building blocks of health systems. By improving service delivery, we can improve access and availability to health services.

Take electrification and how it impacts women in my country, for example. Nearly two-thirds of health facilities don't have electricity. Our research has shown that electrification is associated with improvements in antenatal care, vaccination rates, emergency capabilities and primary health services. Many facilities report improved oxygen supplies, refrigeration and medical supply chains with electrification. Unavailable and unreliable electricity is a bottleneck for health service delivery in LMICs. Electrification is also associated with increased service availability, readiness and quality of care – especially for women, children and those under critical care.

It's also unfair to look only at hospitals and facilities and doctors and equipment, etc. We also need to understand the social determinants of health and try to reduce the primary drivers of problems. If women and young girls are dying as a result of very early pregnancy because of gender inequality or harmful social norms, we need to work on these things. “Correcting beliefs” is a very colonial and unacceptable approach. Trying to reach common ground where we agree women should be able to enjoy a normal social life and a normal, productive life is, in my opinion, a more respectful and inclusive approach that would bring positive and sustainable outcomes with less friction in the future.

What recommendations would you provide to policymakers and organizations to better support youth leaders in their efforts to promote youth sexual and reproductive health?

Dr. Osman: We need to take a human-centric approach, rather than a siloed approach. Different organizations working across different development sectors need to come together to solve the problems being raised by youth leaders. Going back to my previous example – a young girl in a conflict setting who has HIV, who dropped out from school, and is in an economically difficult position needs to be looked at as whole person with several issues, rather than an HIV case by one organization, illiterate by another, and poor by the third.

Organizations based and led in the Global North also need to shrink and integrate. Integration of problems will eventually lead to integration of actors and ultimately lead to integration of actions. We need to have different kinds of conversations, different kinds of research, using qualitative and quantitative research tools, to give context to the problems that donors and different people are trying to solve. We need multi-sectoral interventions to solve the problems of young people in the region.

This is the first time the Women Deliver Conference has been held in Africa – is that significant for you as a Young Leader?

Dr. Osman: It is indeed very significant. I was recently reading The Impatient Dr. Lange: One Man's Fight to End the Global HIV Epidemic, about Joep Lange, a Dutchman who was president of the International AIDS Society. The author wrote about the first time the AIDS Conference was held in Durban, South Africa, in 2000 and the impact that had. What Women Deliver is doing now, bringing the conference to the African region, will hopefully be a good chance for several Africa's young leaders and people from lower and middle-income countries to come and present their work. It also shows an awareness that we need to be in the places where these problems are taking place. Rwanda itself is a great example for development on different levels, including its work on SRHR policies and outcomes. But in my opinion, there is still a big elephant in the room, which is that the Global North needs to show a genuine will to engage people from the Global South. Ultimately, I hope this may be the start of funding shifting from Geneva, Seattle, and Washington to where the actual work is taking place.

This interview was edited for length and clarity.